Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Which Revive program are you applying for?

Describe your current workout & eating habits in detail.

What other programs have you tried in the past? What was your success like?

We practice flexible dieting with Calorie & Macronutrient tracking. What is your familiarity like with this style?

Why do you want to be a part of the Revive program? Why do you feel it is the right fit for you?

Please describe your medical history/current. Ailments, injuries and anything else you believe your coach should know in order to provide the best service possible.

What is your preferred start date? (MAJOR Holidays like Christmas & Thanksgiving are OFF days if they fall in the middle of your program. Beyond that no other OFF days will be given)

What is your preferred form of payment? I accept PayPal, Venmo, cash app and Apple Pay. Please specify along with username or other information in order to receive invoice if accepted.

Upon completion of your application, you will be required to sign all included documents, upload and send full body/ side photos and submit back via email to: whimsyfitmomof3@gmail.com Please allow up to 5 days to process.

By signing below you’re stating that all information is true, and releasing Fitness with Lindsay, Lindsay Simpson of any liability during your time in and after this program, and participating at your own risk in all aspects. No refunds will be given at any time.

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