CampPhewZ Registration Form
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
-
Month
-
Day
Year
Date
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Fitness Enrollment Information
Sessions Per week
*
Please Select
Once a week
2x a week
3x a week
4x a week
5x a week
Program
*
Basketball Training
Football Training
Boxing Training
Sports Performance Training
Cardio Planning
Muscular Strength Program
Endurance Training
Body Flexibility Classes
Ultimate Access Pack
Which is your preferred method of training?
*
In-Person
Virtual
Group training (virtual)
Group training (in-person)
Preferred payment method for this style of training
*
Weekly
Monthly
Annually
Per session
Amount you are willing to invest for this style of training (type dollar amount)
*
Other
How soon do you plan to start? ($100 Deposit is due before your first session.)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Other
Do you wish to receive information to become a brand ambassador?
*
Yes
No
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Self Assessment Information
Have you done any workout programs before?
*
Yes
No
Please specify your experience.
*
What are your goals with a coach?
*
Other
How do you rate yourself athletically?
*
1
2
3
4
5
6
7
8
9
10
Worst
Best
1 is Worst, 10 is Best
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Medical Information
Any allergic reaction to medicines (e.g. aspirin, penicillin, etc.)?
*
Please provide and explain.
Are you currently taking any prescribed medications? If so, what are they for?
*
Are you experiencing any epileptic seizures?
*
Please Select
Yes
No
Do you have Asthma?
*
Please Select
Yes
No
Have you had any operation in the last two years?
*
Please Select
Yes
No
Please specify, which operation have you had?
*
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Disclaimer
Submit
Date
*
-
Month
-
Day
Year
Date
Signature
*
Should be Empty: