PRIVATE OR SMALL-GROUP FITNESS OR SELF-DEFENSE/JIU-JITSU TRAINING
All Fitness Training is done at Fithouse24 in Overland Park, KS
ALL Self-Defense or BJJ Training is TBD location based on goals.
contact me with questions

CLICK HERE TO Contact me with questions

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FORMS

ONLINE TRAINING QUESTIONNAIRE

Full Name *

Email Address *

Phone Number

GenderMaleFemale

Age

Fitness Goals (be specific) *0 / 500

Current Activity LevelMostly SedentaryMinimal Movement (walking dog, short activities)Semi-Active (scheduled workouts or activities 2x/week)Active (scheduled workouts or activities 3+times/week)Very Active (movement most of the day + scheduled workouts or activities)

Are your tracking your workouts by any method? *

Preferred Workout TypesStrength TrainingCardioHIITOther

Additional Information or Injuries0 / 500

Submit

ONLINE NUTRITION COACHING QUESTIONNAIRE

Full Name *

Gender *MaleFemale

Email Address

Phone

Height *

Current Body Weight & Body Fat % (if known) *

Goal Body Weight or Body Fat % *

Medical Conditions (if any)0 / 500

Medications and Supplements (include any HRT) *0 / 500

Current Diet and Exercise Routine *0 / 600

Are You Using a Food Prep Service? *

Are you using any method to track workouts or food intake? *0 / 180

Weight loss goals and motivation *0 / 600

Do you have a specific time line or event? *0 / 400

Submit

LIABILITY RELEASE

Assumption of Risk & Liability Waiver
I voluntarily choose to participate in a fitness or nutrition program as facilitated by Benda Strength & Conditioning, LLC (“Program”).
I understand that the Program may include, but is not limited to, physical exercise, strength training,
cardiovascular activity, mobility work, wellness challenges, nutrition education, stress management activities,
and other health-related activities. I acknowledge that participation in physical activity carries inherent risks, including but not limited to muscle strains, sprains, abnormal blood pressure, heart conditions, falls, serious
injury, or, in rare cases, death.
I certify that I am physically able to participate in this Program and have either consulted with a healthcare provider or voluntarily chosen not to do so. I agree that it is my responsibility to consult with a physician prior to
and regarding participation in any physical fitness program, especially if I have any medical condition, injury, or concern.
I knowingly and voluntarily assume full responsibility for any risks, injuries, or damages, known or unknown,
that I may incur as a result of participating in the Program.
To the fullest extent permitted by law, I hereby release, waive, discharge, and hold harmless Benda Strength & Conditioning, its owners, officers, employees, agents, contractors, and representatives from
any and all claims, liabilities, demands, causes of action, damages, or costs arising out of or related to my participation in the Program.
I understand that participation is voluntary and that I may withdraw at any time.
I acknowledge that Benda Fitness or Ethan Benda is not providing medical advice and that the Program is intended for general wellness purposes only.
By submitting this form, I acknowledge that I have read this waiver, fully understand its terms, and agree to be bound
by them.