1:1 coaching form — Georgia Radley Nutrition

1:1 Coaching Sign Up Form
The first page of this form will collect your contact details as well as an emergency contact. The details you provide on this form are confidential. If you have any questions please email me at georgia@georgiaradleynutrition.com and I will be more than happy to answer!
Name*

First NameLast Name
Date of birth*

MonthDayYear
Date
Sex*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Emergency contact details*

NameRelationshipContact number

Terms + Conditions, Coach/Athlete Agreement + Waiver
Please disclose any medical condition(s) you have and outline any treatment(s) you have received or are currently receiving.*
If you have any medical conditions, please pay special attention to the Liability Release section of the terms and conditions and ensure you have consulted your doctor before proceeding with this programme. If you currently have an eating disorder, unfortunately this programme is not appropriate for you to participate in, but you may contact me at georgia@georgiaradleynutrition.com and I will refer you to the appropriate professional(s).
Please read the Terms and Conditions in full - including the liability release, results agreement, non-disclosure agreement and privacy policy - attached below.
Please read the Coach + Athlete Agreement - attached below.
Check each box to confirm that you have read and agreed to:*
By signing below you confirm that you have read, understood and agreed to the terms and condition in full, as well as the coach/athlete agreement.
Signature*

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My Products

Your bespoke coaching packageMonthly cost is calculated based on the details you have provided in this form

GBP for the first month then,GBP for each month

Enter coupon

Total

£0.00

1:1 Coaching Sign Up Form