New Client Form
New Client Intake
A few questions about you, your health and your goals, then the waiver and your signature. It takes about five minutes. Your answers stay private and only I read them.
Stretch with Shawn
New Client Intake
Please fill this out in ink and bring it to your first session.
Section 1: About you
Full name
Phone
Date of birth
Emergency contact name
Emergency contact phone
How did you hear about me? (optional)
Section 2: Health and safety
1. Do you have any past or current injuries?
Yes No
If yes, details:
2. Any surgeries, past or recent?
Yes No
If yes, what and when:
3. Any range of motion limits or areas that feel stuck, tight or painful? (optional)
4. Is there anything you are worried about being stretched or moved? (optional)
5. Check any that apply (optional):
Pregnant or possibly pregnant
Hypermobile or very flexible joints
Recent surgery (last 12 months)
Injury that a doctor has cleared
Surgical implants (stent, shunt, mesh, pacemaker, etc.)
Heart condition or blood pressure concerns
History of blood clots
Epilepsy or seizures
None of these
Section 3: Your goals
Check all that apply:
Balance and steadiness
Strength
Flexibility
Splits
Ankle mobility
Hip mobility
Shoulder mobility and rotation
Posture
Back and neck comfort
Athletic performance
Sport specific
Recovery and soreness
Stress relief and nervous system regulation
Fall prevention
Other
Which sport or activity? (if sport specific)
Anything else you want me to know? (optional)
Section 4: Waiver
Please read the full agreement below before signing.
This Waiver and Release applies to all services provided by Shawn Taylor, doing business as Stretch with Shawn ("Stretch with Shawn"), including but not limited to personal training, corrective exercise, assisted stretching, soft tissue techniques, mobility work, vibration based services, and related wellness or recovery services.
Please read this agreement carefully before booking or receiving any services.
PARTICIPATION AND SCOPE OF SERVICES
By booking, participating in, or receiving services, you acknowledge that these services involve exercise, strength training, physical movement, hands on assistance, pressure, stretching, compression, vibration, changes in body position, and the use of equipment.
You understand that participation is voluntary and that results may vary based on individual health, condition, and feedback.
This agreement applies to services provided at any location, including but not limited to gyms, studios, private businesses, rented facilities, events, outdoor locations, private residences, or any other property where services are offered.
NON MEDICAL CARE DISCLOSURE
You acknowledge and agree that Stretch with Shawn does not provide medical care, physical therapy, chiropractic services, diagnosis, rehabilitation, or treatment of any medical condition.
Services are not a substitute for medical advice or healthcare. No medical claims are made regarding any services provided.
You understand that it is your responsibility to consult a qualified healthcare professional regarding any medical concerns prior to participation.
ASSUMPTION OF RISK
You understand and voluntarily accept the inherent risks associated with exercise, wellness and bodywork services, including but not limited to muscle soreness, strain, dizziness, lightheadedness, discomfort, changes in blood pressure or heart rate, aggravation of existing injuries or conditions, or other physical responses.
You voluntarily choose to participate with full knowledge of these risks and assume full responsibility for any injury, discomfort, or adverse effects that may occur.
CLIENT RESPONSIBILITIES AND CONSENT
By participating, you certify and agree that:
- You are physically able to participate in exercise and wellness services
- You are not under medical instruction that would prohibit participation
- You will disclose any injuries, medical conditions, surgeries, implants, limitations, or concerns prior to your session
- You understand it is your responsibility to know your physical limits
You agree to immediately communicate discomfort, pain, dizziness, or unease and to stop the session if necessary.
You acknowledge that assisted stretching and related services require professional physical contact and you consent to this contact solely for the purpose of providing the service. You agree to communicate preferences, boundaries, and concerns at any time.
VIBRATION AND DEVICE SPECIFIC DISCLOSURES
You understand that you should NOT use vibration based devices if you:
- Are pregnant
- Have a retinal tear or detachment
- Have blood clots or any form of thrombosis
- Have unstable angina
- Have epilepsy or are prone to seizures
You agree to consult your physician before receiving services if you:
- Have a heart condition
- Recently had surgery
- Have surgical implants including shunt, stent, mesh, venous filter, aneurysm clip, or pacemaker
- Have any condition that may be worsened by movement, stretching, pressure, vibration, sound, light, or position changes
You understand that vibration may cause itching or discomfort in some individuals and agree to notify your coach if symptoms occur.
You agree not to participate while under the influence of alcohol, recreational drugs, or any substance that may impair judgment, sensation, or communication.
MINORS
Participants under the age of 18 may not consent for themselves.
A parent or legal guardian must complete and agree to this waiver on the minor's behalf. By consenting, the parent or legal guardian:
- Confirms they are the lawful parent or guardian
- Consents to the minor receiving services
- Assumes full responsibility for the minor's participation
- Agrees that all terms of this waiver apply fully to the minor
RELEASE, WAIVER, AND HOLD HARMLESS
To the fullest extent permitted by law, you agree to release, waive, indemnify, and hold harmless Shawn Taylor, Stretch with Shawn, and any contractors, agents, and affiliates, as well as any gym, facility, property owner, or venue where services are provided, from any and all claims, demands, damages, injuries, losses, or liabilities arising out of or related to:
- Participation in services
- Your actions or omissions
- The participation of any minor for whom you consent
This release includes claims based on negligence to the fullest extent permitted by law.
PHOTOGRAPHY & MEDIA
Photos or video of your sessions will only be used in marketing materials, social media, or the website if you give permission on the intake form. If you appear in any photo or video and wish to have it removed please contact info@stretchwithshawn.com and it will be removed promptly upon request. Images of minors will never be used without explicit written parental consent.
BINDING AGREEMENT AND DIGITAL SIGNATURE
This agreement is binding upon you and your heirs, assigns, and representatives.
By typing your full name and submitting this form, you confirm that you have read, understand, and voluntarily agree to this Waiver, Release of Liability, and Hold Harmless Agreement. Your typed name acts as your digital signature.
I have read and agree to the Waiver and Release of Liability.
Section 5: Photo release and signature
I give permission for photos and video of my sessions to be used on the Stretch with Shawn website and social media. I can ask to have anything removed at any time. (optional)
I am 18 or older.
I am the parent or legal guardian of the participant.
Participant name (if guardian)
Participant date of birth (if guardian)
Type your full legal name
By typing my name, I agree this acts as my electronic signature.
Date