Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Select Service *Book for Personal TrainingBook for Performance TrainingBook for Group TrainingBook for a Community Event, Class, or an Educational PresentationName *FirstLastEmail Address *Phone *How motivated are you to begin seriously focusing on improving your health? *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Age *What is your current fitness level/exercise background? * I am a beginner I rarely miss a day 012345678910 Which of the following types of physical activity do you currently participate in? *None, I am not currently activeOutdoor activities (Hiking, kayaking, paddle boarding, camping, climbing, etc.)Water sports (Skiing, knee boarding, tubing, wake surfing)Endurance sport (Cycling, running, swimming, obstacle courses, rowing, CrossFit, etc.)General fitness (Cardiovascular and/or weight training)Organized sports (basketball, volleyball, soccer, football, gymnastics, hockey, etc..)Powerlifting (Strength competitions, Olympic style lifting, strong man events, etc.)Bodybuilding (Building muscle, physique or bikini shows)Pilates / YogaDance / balletOther(Check all that may apply)Physical restrictions / limitations? *ArthritisHypertension (High blood pressure)OsteoporosisRecent surgery and/or hospitalizationDiabetes (Type I or II)Environmental allergies (Sun, grass, pollen etc.)Cardiovascular or heart diseaseNone of theseOther(Check all that may apply)How motivated are you to begin seriously focusing on improving your health? *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Age *What is your current fitness level/exercise background? * I am a beginner I rarely miss a day 012345678910 Which of the following types of physical activity do you currently participate in? *None, I am not currently activeOutdoor activities (Hiking, kayaking, paddle boarding, camping, climbing, etc.)Water sports (Skiing, knee boarding, tubing, wake surfing)Endurance sport (Cycling, running, swimming, obstacle courses, rowing, CrossFit, etc.)General fitness (Cardiovascular and/or weight training)Organized sports (basketball, volleyball, soccer, football, gymnastics, hockey, etc..)Powerlifting (Strength competitions, Olympic style lifting, strong man events, etc.)Bodybuilding (Building muscle, physique or bikini shows)Pilates / YogaDance / balletOther(Check all that may apply)Physical restrictions / limitations? *ArthritisHypertension (High blood pressure)OsteoporosisRecent surgery and/or hospitalizationDiabetes (Type I or II)Environmental allergies (Sun, grass, pollen etc.)Cardiovascular or heart diseaseNone of theseOther(Check all that may apply)How many are in your small group? *Myself +1Myself +2Myself +3How motivated are you to begin seriously focusing on improving your health? *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Age *What is your current fitness level/exercise background? * I am a beginner I rarely miss a day 012345678910 Which of the following types of physical activity do you currently participate in? *None, I am not currently activeOutdoor activities (Hiking, kayaking, paddle boarding, camping, climbing, etc.)Water sports (Skiing, knee boarding, tubing, wake surfing)Endurance sport (Cycling, running, swimming, obstacle courses, rowing, CrossFit, etc.)General fitness (Cardiovascular and/or weight training)Organized sports (basketball, volleyball, soccer, football, gymnastics, hockey, etc..)Powerlifting (Strength competitions, Olympic style lifting, strong man events, etc.)Bodybuilding (Building muscle, physique or bikini shows)Pilates / YogaDance / balletOther(Check all that may apply)Physical restrictions / limitations? *ArthritisHypertension (High blood pressure)OsteoporosisRecent surgery and/or hospitalizationDiabetes (Type I or II)Environmental allergies (Sun, grass, pollen etc.)Cardiovascular or heart diseaseNone of theseOther(Check all that may apply)How many are in your small group? *Myself +1Myself +2Myself +3 Which Training do Organization *Address of Event *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of Event *More InformationName of Parent/Guardian *FirstLastPhone of Parent/Guardian *Signature of Parent/Guardian * Clear Signature I HEREBY CERTIFY that I am the parent or guardian of the youth (under the age of 18) participant named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.Submit
