Team 3DMJ New Athlete Application

New Athlete Application
GENERAL ATHLETE INFORMATION
Name*

First NameLast Name
Which coaching service are you interested in applying for? (No payment is required to submit this application)*
Gender Identity - please let us know how you prefer to be identified, feel free to leave blank if preferred:
Sex assigned at birth*
Date of Birth*

MonthDayYear
Age*
Email Address*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Please select your time zone*
Are you currently working with another coach/trainer?*

YesNo
Current Bodyweight*
Units (bodyweight)*

lbskgs
Height*
Units (height)*

inchescm
Please describe your weight history*
What are your short term goals over the next 8-12 weeks? OR, if you are not looking for programming, what would you like to discuss during your consultation?*
What are your long term goals?*

RESISTANCE TRAINING
Please summarize your current weight training split/regimen.*
What, if any, equipment limitations do you have/anticipate having?*

NUTRITION
Describe your current nutrition intake, include total calories, carbs, protein and fats. If unknown, list your food intake (type and amount) for a typical day. *
Do you have any food allergies or intolerances? Any additional information relevant to your nutritional status?*

CARDIOVASCULAR WORK & ACTIVITY OUTSIDE OF GYM
Describe your typical level of daily physical activity outside of the gym. Do you have an idea of your average step count/day?*
What is your current cardio regimen? Include schedule, intensity and type:*

SUPPLEMENTATION
List all supplements you use, including their frequency and dose:*

MEDICAL HISTORY
Please list any medical diagnoses (e.g. Kidney disease, type II Diabetes, hypertension, PKU, etc.) – If none, type “N/A”*
If you listed any medical diagnoses above, are those conditions stable as determined by a qualified health care professional? (Yes, No, or N/A) *
Please list any injuries or ongoing pain that currently inhibits your ability to train as desired. If none, type “N/A”.*
Family history of medical diagnoses (Who? What? Example: Mother- Type II Diabetes):*
Medication History (Past meds):*
List all medications you currently take (insulin, birth control, TRT, HRT, etc.), including their frequency and dose. Please include what each medication is for, if not obvious.:*
Menopause Status (if applicable)*

LIFESTYLE
Can you balance the time you spend focused on your food, your body weight and composition, and your nutrition plan progress with other aspects of your life such as your relationships, work, and personal development?*
Please list any prominent stressors you have at this time:*
Has your weight or shape influenced how you think about (judge) yourself as a person? *
Do you have any food or exercise rituals that concern you? If yes, please explain:*
During the past month, have you often been bothered by feeling down, depressed, or hopeless?*

PHYSIQUE PHOTOS

Please either have someone help you take photos or use a self timer (no mirror selfies). It is also preferred to have you facing a natural light source.
Current photo displaying your physique (front pose)*

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Current photo displaying your physique (back pose)*

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Photo from your last contest (optional, but is very useful with our evaluation of your physique)

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WAIVER
We state: 3D Muscle Journey, LLC (3dmusclejourney.com) is not a licensed dietitian or nutritional specialist. All information you obtain will be directly from 3D Muscle Journey, LLC’s own experiences. It is of best interest for anyone looking to start a bodybuilding contest preparation/ fitness program to consult a physician before doing so; it would be wise to have blood work done, and a physical performed by a licensed physician.

Before submitting this application, please read and understand the following: You (customer) totally understand that you (customer) may injure yourself as a result of participation in a bodybuilding contest preparation/fitness program, and hereby release 3D Muscle Journey, LLC (3dmusclejourney.com), Jeff Alberts, Brad Loomis, Alberto Nuñez, Eric Helms, Brian Minor (BDMinor LLC), Steve Taylor (Steve Taylor RD), Amanda Rizo (LPCC #8037), and Nicholas M. Licameli (Strength Together Inc.) from any liability now or in the future for any injury, including, but not limited to heart attacks, death, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury however caused , occurring during or after my participation in the bodybuilding contest preparation/fitness program offered.

By submitting this application, you state that in consideration of your participation in 3D Muscle Journey, LLC’S (www.3dmusclejourney.com) bodybuilding contest preparation program, you for yourself, your personal representatives, administrators, heirs and assigns, hereby holds harmless, 3D Muscle Journey, LLC (3dmusclejourney.com), Jeff Alberts, Brad Loomis, Alberto Nuñez, Eric Helms, Brian Minor (BDMinor LLC), Steve Taylor (Steve Taylor RD), Amanda Rizo (LPCC #8037), and Nicholas M. Licameli (Strength Together Inc.) from any claims arising from your participation in the bodybuilding contest preparation/fitness program. By submitting this application, you agree that you have listed all current/past medications and diagnoses, and that you have spoken with your doctor and been cleared to participate in your planned activities

By submitting this application, you agree that you have are being seen by a physician for your current medical diagnoses/medication regiment, and if for any reason you stop seeing your current physician for the above conditions/medications you will inform 3D Muscle Journey, LLC. By submitting this application, you affirm that you have read, have been honest with 3D Muscle Journey, LLC (3dmusclejourney.com), Jeff Alberts, Brad Loomis, Alberto Nuñez, Eric Helms, Brian Minor (BDMinor LLC), Steve Taylor (Steve Taylor RD), Amanda Rizo (LPCC #8037), and Nicholas M. Licameli (Strength Together Inc.) and also fully understand the above information.

You have been given the opportunity to present questions in all related matters. You agree that if at anytime the status of your condition changes you will inform 3D Muscle Journey, LLC. Do you Agree with the Terms of this Waiver?
I Agree
***NOTE: If you click “Submit” and do not see a confirmation screen that says “Thank You! Your submisson has been received.”, then your form did not go through. Scroll back up and make sure ALL boxes were filled and ALL photos were able to upload correctly. Thanks!
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New Athlete Application

GENERAL ATHLETE INFORMATION

RESISTANCE TRAINING

NUTRITION

CARDIOVASCULAR WORK & ACTIVITY OUTSIDE OF GYM

SUPPLEMENTATION

MEDICAL HISTORY

LIFESTYLE

PHYSIQUE PHOTOS

WAIVER