Application form

Training application

Let us know more about you before starting!
Name
Address
Email
example@example.com
Mobile Phone number
Height
Weight
Gender
Date of birth

MonthDayYear
Date
Please tick the following goals that are important to you

Weight lossImproved healthImproved endurance/staminaImproved muscle definition/toneImproved strengthMuscle gainSport specific improvementsImproved confidence
Please list your main “specific goal” (with an approximate timeline of needed) in 1 sentence .
Eg. “I want to lose 2 stone so I can fit into my favourite dress for my birthday on date _X_” OR “I want to be able to do 10 press ups before my 50th birthday in month X..... OR “I want to feel good in my clothes by creating sustainable habits .”
What made you apply to Your Next Level Fitness ?

I’ve seen good results on websiteSaw on Facebook / instagramSaw on GoogleSaw advert on the carI know someone who trains hereOther
What are your main obstacles when it comes to getting/staying in shape?
Why now? Why not last week, or last month or last year?
EXERCISE HISTORY
Would you consider yourself

A beginnerAn intermediateExperiencedNot sure
How often do you exercise vigorously?

4 times a week or more1-3 times a week1-2 times a monthLess than once a monthI haven’t exercised in a long time
What have you tried before ?
Eg exercise classes , weight watchers , slimming world, trying to eat less by myself, running , etc
How was your success ?
Commitment
On a scale of 1-10 , (10 being most) how READY are you to start?
On a scale of 1-10 , (10 being most) how WILLING are you to get your goal?
On a scale of 1-10 , (10 being most) how ABLE are you to start?
Is there anything that is stopping you being totally ready, willing and able? If so, how can we navigate that hurdle?🤔
How many hours per week can you commit to exercise?
Medical
Do you drink alcohol?

YesNo
If the answer is yes , how many units do you drink PER MONTH
175ml glass is 2units ; 1 pint of 5% beer is 3 units
Do you smoke?

YesNoWhen I drink / when I’m in a certain situationNo, but I used to smoke
If you currently smoke , how many ?
Lifestyle
What do you do for a living
Eg. Job or care for children etc
What is your level of physical activity during a normal day

None / low (mainly sitting )MediumHigh
Does your job require shift work ?

YesNoNot applicable
Sleep amount
Sleep quality
How much coffee or tea do you drink?
Do you suffer from....?

IndigestionBelching or gasBloated ness after certain foodsBad breathLess than 1 bowel movement per dayExhausted after moderate exerciseAnxietyHeartburn
How much water do you usually drink? (For example 200-250ml glasses)
What times of day do you prefer to exercise?

6am-9am9am-12pm12pm-3pm3pm-6pm6pm-9pmOther
How often do you travel for work?

RarelyA few times per yearOnce a month or soMost weeks
Do you have children?

YesNo
If yes, how many and how old are they ?
Please list any physical activities you participate in outside of work
How often do you go food shopping?
How often do you eat out or get a take away?
If you have any food allergies or foods you dislike - please list below
Have you had to consult your doctor within the last 12 months? If yes,please give details....
Please tick if you suffer from :

AsthmaHeart issuesDiabetesEpilepsyBronchitisStroke or aneurysmMarfans syndrome or hyperflexibilityAnaemia
If answered “yes” to any of the above, please give more detail:
Are you presently taking any form of medication?
Do you suffer from any musculoskeletal issues ?
Eg. Knee pain , hip pain
What’s your time frame (can pick multiple )

8-12 weeks hard3-12 months slower and steadyLong term Lifestyle
Signature
Terms and conditions
I am taking part in this exercise to improve my muscle tone , strength and fitness.

I understand there will be activities of a strenuous nature, and also resistance-based training as well as stretching .

I declare I am in good physical condition and do not suffer from any ailment that would be adversely affected by physical activity . I acknowledge any issues within myself and have mentioned above.

I understand that I may be asked to provide medical clearance prior to receiving an exercise prescription due to my responses in the health questionnaire . I understand the risks involved with all aspects of exercise - such as soreness, injury, possible stroke/heart-related issues and will cease participation if I feel I need to. I release Your Next Level Fitness of any claims made and will not do an exercise if I feel unwell or unsafe.

If I am exercising in the gym and require Information, I will ask about concerns of exercises etc.

If I cancel within 24 hours , I understand my session may be lost . If for whatever reason the coach is absent - you will be entitled to the session lost , plus a complimentary session .
Should be Empty:

Training application

EXERCISE HISTORY

Commitment

Medical

Lifestyle