Home
About KDA
Classes
Pricing
Contact
Client Forms
Client Intake Form
KDA Personal Training Membership Contract
KDA Waiver and Hold Harmless Agreement
Book Appointment
Client Intake Form
KDA Fitness Client Intake Form
Phone
This field is for validation purposes and should be left unchanged.
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Date of Birth
(Required)
MM slash DD slash YYYY
Emergency Contact
Name
(Required)
First
Last
Relationship
(Required)
Phone
(Required)
Health & Disability Information
(Your responses help us create the safest and most effective fitness plan.)
1. Disability / Medical Conditions
Please describe your disability or medical condition(s):
2. Mobility & Functional Abilities
Do you use any mobility aids? (Check all that apply)
(Required)
Wheelchair
Walker
Cane
Crutches
Other
Are you able to stand independently?
(Required)
Yes
No
With Assistance
3. Sensory or Communication Needs
Do you have any sensory preferences or challenges (light, noise, touch)?
(Required)
Preferred communication style (verbal, written, AAC device, gestures):
(Required)
4. Medical & Safety Information
Do you have seizures?
(Required)
Yes
No
If yes, describe triggers and protocols:
(Required)
Do you have any heart or respiratory conditions?
Yes
No
If yes, describe:
(Required)
Do you have any doctor-imposed exercise restrictions?
(Required)
Yes
No
If yes, list restrictions:
(Required)
Do you require assistance with: (check any)
Balance
Transitions (standing/sitting)
Lifting or moving
Understanding instructions
Behavior/emotional regulation
Other
5. Fitness Goals
What are your goals for training? (Check all that apply)
(Required)
Strength improvement
Mobility improvement
Balance/fall prevention
Weight management
Sports or recreation
Independent living skills
General exercise & wellness
Other
Additional Notes or Concerns
Notes or Concerns
Liability Waiver & Release Form
This document affects your legal rights. Please read carefully before signing.
Terms and Conditions
(Required)
Assumption of Risk
I understand that participation in physical exercise, strength training, or fitness activities at KDA involves inherent risks, including but not limited to falls, equipment-related injuries, muscle strain, cardiac events, or aggravation of existing medical conditions. I acknowledge that KDA staff will take reasonable steps to promote safety but cannot eliminate all risks.
I voluntarily choose to participate in training at KDA and assume full responsibility for any injury, accident, or harm that may occur.
Medical Disclosure
I affirm that the information provided in my intake form is accurate to the best of my knowledge. I understand that failing to disclose medical or disability-related information may increase my risk of injury.
I acknowledge that KDA staff are not medical professionals and do not diagnose, treat, or prescribe for medical conditions.
Release of Liability
In consideration for participating in services at KDA, I hereby release and discharge KDA, its owners, staff, trainers, agents, and representatives from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or harm that I may sustain while participating in activities at or associated with KDA.
This release includes any injuries caused by negligence of KDA staff, except in cases of gross negligence or intentional misconduct, as defined by applicable law.
Emergency Care Consent
In the event of a medical emergency, I authorize KDA staff to seek emergency medical treatment on my behalf. I agree to be responsible for any resulting medical expenses.
I acknowledge that I have read and understood this Liability Waiver and Release Form. I agree to its terms voluntarily.
I confirm that I have read and understood the terms outlined above.
Photography/Video Consent (Optional)
I give consent to KDA to use photos/videos of me for marketing and documentation.
I do NOT consent.
Signature
(Required)
Client Name
(Required)
First
Last
Parent / Guardian Signature (if applicable)
Δ
English
English
Deutsch
Español
Français
Italiano
Polski
Svenska
Suomi
Português
Română
Slovenščina
Slovenčina
Nederlands
Dansk
Ελληνικά
Čeština
Magyar
Lietuvių
Latviešu
Eesti
Hrvatski
Gaeilge
Български
Norsk
Türkçe
Bahasa Indonesia
Português (Brasil)
日本語
한국어
简体中文
العربية
Русский
हिन्दी
Українська
Srpski
English (UK)
ایران
ישראל
Македонија
ประเทศไทย
Việt Nam
Accessibility Adjustments
Powered by
OneTap
Hide Toolbar
Back
How long do you want to hide the toolbar?
Hide Toolbar Duration
Only for this session
24 hours
A Week
Not Now
Hide Toolbar
Select your accessibility profile
Vision Impaired Mode
Enhances website's visuals
Seizure Safe Profile
Clear flashes & reduces color
ADHD Friendly Mode
Focused browsing, distraction-free
Blindness Mode
Reduces distractions, improves focus
Epilepsy Safe Mode
Dims colors and stops blinking
Content Modules
Font Size
+
Default
-
Readable Font
Line Height
+
Default
-
Cursor
Letter Spacing
Align Text
Font Weight
Color Modules
Light Contrast
High Contrast
Monochrome
Orientation Modules
Reading Line
Reading Mask
Hide Images
Highlight Content
Stop Animations
Highlight Links
Reset Settings
Customize
Reject All
Accept All
Powered by
✖
►
Necessary Cookies
Always Active
Necessary cookies enable essential site features like secure log-ins and consent preference adjustments. They do not store personal data.
None
►
Functional Cookies
Remark
Functional cookies support features like content sharing on social media, collecting feedback, and enabling third-party tools.
None
►
Analytical Cookies
Remark
Analytical cookies track visitor interactions, providing insights on metrics like visitor count, bounce rate, and traffic sources.
None
►
Advertisement Cookies
Remark
Advertisement cookies deliver personalized ads based on your previous visits and analyze the effectiveness of ad campaigns.
None
►
Unclassified Cookies
Remark
Unclassified cookies are cookies that we are in the process of classifying, together with the providers of individual cookies.
None