Registration Form
Name
*
First Name
Last Name
Birth Date
*
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Year
Gender
*
Please Select
Male
Female
N/A
Mobile Number
Format: (000) 000-0000.
Best E-mail
Height
*
Weight
*
Lifestyle
What do you do for a living?
What's the activity level at your job?
*
Please Select
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Additional Comments: Do you follow a regular working schedule, do you work days, afternoon or nights?
*
If you have any diagnosed health problems list the condition(s). If you are on any medications, please list them.
Outside the gym do you participate in other physical activities?
*
At what times during the day would you prefer to train?
*
Morning
Mid-Day
Afternoon
Evening
Please attach current front and back photos
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If you have any injuries, please list them in detail.
How much sleep do you get per night?
Less than 6hrs
6hrs
7hrs
8hrs
9hrs or above
Nutrition
What type of health supplements are you currently taking or have previously taken before?
How much water including diet sodas are you drinking per day?
Do you have any known food intolerances or foods that you prefer not to eat?
*
What does your current diet look like? More detail the better
Have you had, any blood work done? If you have had recent blood work done please upload screenshot below for analysis
Yes
No
What’s your most unhealthy foods you eat out or often
What’s your favourite healthy foods?
Comments
Terms & Conditions
1.) CANCELLATIONS Initial plan and upfront payments are non-refundable however monthly coaching can be terminated at any time.2.) UPDATES Updates must be sent as scheduled with front and back photos attached and current weight average week weight unless you have made your coach aware in advance of something preventing this or in the case of an uncontrollable event taking place preventing this. Update photos must be sent before 11am (NZDT) to ensure enough time for an updated plan/response from your coach.3.) ALL OF THE INFORMATION I HAVE GIVEN IS CORRECT All of the information on this form is correct to the best of my knowledge. I understand that all the information given will be kept strictly confidential.4.) MEDICAL HEALTH I have sought and followed any necessary medical advice. I am fit and able to begin a diet and/or training program. I have no known existing medical conditions that I have not mentioned above.
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Signature
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