Acceleration Australia

Client's Personal Details

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Date of Birth

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Sport

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Client's Contact Details

Home Phone

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Work Phone

Address

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Mother's Contact Details

Mother's Name

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Father's Contact Details

Father's Name

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Client's Health Status

Injury Concerns

Medical Concerns

Comments

Client's Goals

In the next year, what are the two main events/competitions that you are training for?

	Name	Start Date eg. 10-Jul-2010	End Date eg. 15-Jul-2010	Description (if you do not have exact start and end dates, include approximations here)
1.
2.

What is your 'dream' goal?
What is potentially possible in the long-term if you stretch all of your limits?
(E.g. To play for Australia, or Lose 20kg of Body Weight)

What is your 'dream' goal for this year? (E.g. Make the State U/16 Team or Lose 5 kg)

Mark 3 goals in priority order that you want to work on in your Acceleration Australia sessions below:
1=Highest Priority, 2 = Moderate Priority, 3= Lowest Priority

Skill	Rating out of 10 0=Worst 10=Best
	Present today	Target Event Date
Acceleration
Speed
First Step Quickness
Vertical Jump
Flexibility
Upper Body Strength
Lower Body Strength
Upper Body Power
Lower Body Power
Core Strength
Other
Other

List 1 sport skill that you may be working on concurrently with your Acceleration Australia training:

Sport Skill (e.g. increased stroke rate, stronger rebounds, better kicking game, better angled drives)	Rating out of 10 0=Worst 10=Best		What will you do to ensure you reach your target rating? (train 2/week)
	Present today	Target First Event Date

Acceleration Informed Consent

Testing:

The purpose of the performance enhancement testing protocol is to evaluate athleticism, so to find your strengths and weaknesses. There are a variety of tests that will be administered, so as to evaluate all areas of athleticism.

If you are injured, ill or have any reason why you should not participate, please wait until you are in better condition and notify your coach (unless you are doing a rehabilitation test). Participation in the Acceleration performance testing is similar to participating in any sports practice or performance. By your participation, you will assume any athletic risk or injury.

I Agree

Program Design & Implementation:

The performance enhancement training program that will be supplied to you has been designed to suit your individual training needs. Some of the exercises may be very challenging, since we are looking to improve your performance levels. We will always do our upmost to keep our training as safe and effective as possible, but please understand that in order to improve your performance, we must constantly challenge you to try new training techniques. This disclaimer covers all programs that are used in the training centre and away from the centre.

I Agree

Disclaimer:

I hereby assume all risks and responsibilities surrounding my (or my child's) participation in the Acceleration program. I understand that similar to all sporting activities, there is risk of damage to personal property, personal injury, or death which may result from causes beyond the control of, and without fault or negligence of Acceleration, its officers, agents, or employees, during the period of my (or my child's) participation. I have carefully read and understand completely the above agreement and agree to be bound thereby.

I Agree

Videos or Photos

I understand that if I or my child do not want to be in photo or video footage for the use of Acceleration's website or social media, then it is my responsibility to notify the person taking the footage or notify Acceleration prior to commencing training.

I Agree

Commitment

I agree to support the program and it's philosophies on a daily basis. This includes turning up on time, ready to train. I (or my child) will listen to the coaches and give full effort at each training session.

Acceleration does not take responsibility for your child outside of their scheduled training time. Please ensure you take appropriate action to ensure your child is collected after their session.

I Agree

Signature of Client or Parent/Guardian if client is under 18

Acceleration Terms & Conditions

1. Cancellations: You need to contact us before 6pm the day before your session if you want to cancel your training session. After 6pm will be considered late and charged as a missed session unless you can change the session to a day and time in the same week.

The cancellation rule applies to testing sessions. However in the event of a testing session that is cancelled, a $92 re-booking fee will requested because of the significant impact it places on scheduling for the day. In the event of extreme circumstances will be taken into consideration and something will be worked out.

I understand & agree

2. Full Payment: Will be debited from your nominated account no earlier than 24 hours before your first session of a training program. Payments will cease when the client requests no further training.

*Note: Failed payments will incur a $25.00 fee paid by yourself which is charged by Ezidebit.

I understand & agree

3. Arrive On Time: If you are late then we will remove exercises from your program to make sure you finish on time.

I understand & agree

Note: If you change or cancel your testing session on the day of your booking, you will lose your initial deposit.

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