Call For A Free Transformation Session 732-263-0202 | 732-530-4066 1127 Highway 35 Ocean Township, NJ 07712 | 147 Markham Place Little Silver, NJ 07739

Health History


Welcome to Mike Duffy's Personal Training. So that we may train you to the best of our ability, please take a few minutes to answer the questions listed below. Thank you.

(Ex.: Lose weight, tone, strengthen body, rehabilitate an injury, athletic conditioning)

RElEASE WAIVER REQUEST TO PARTICIPATE FORM

I consent to voluntarily participate in Mike Duffy's Personal Training exercise and nutrition program. have an understanding of my target heart range and understand it is my responsibility to monitor my level of exertion and pace myself accordingly.

I hereby release Mike Duffy's Personal Training and its staff and representatives from any responsibility and liability for any injury or health consequence as a result of negligence on the part of Mike Duffy's Personal Training that may occur from participation in this personal training exercise and nutrition program.

On occasion clients' personal information (including name, hometown, image) are captured in photographs and videotapes made for display of training activities. Some of the identifiers are used in the Mike Duffy Personal Training Studios, local media, mailers, emails and on the Mike Duffy Personal Training website and social media sites for promotional purposes only.

Signature below indicates permission for Mike Duffy to publish and use information as described above.

I have read and understand the foregoing. Any questions, which may have occurred to me, have been answered to my satisfaction.

I confirm that I want to receive content from Shamrock Fitness, Inc. DBA Mike Duffy's Personal Training using any contact information I provide.