Powerlifting - Application Form

Powerlifting - Application Form
Please complete the form below to apply for Powerlifting Coaching at Health & Performance.

Once received you will be contacted to discuss your application, so please provide as much accurate information as possible.

Thank you!
Name*

First NameLast Name
Email*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Date of Birth*

DayMonthYear
Date

Training History

This gives us a complete picture of your exercise and powerlifting background, and the level of training you may be accustomed to.
Describe your current training / exercise schedule.*
Describe your powerlifting history, if any. Include competition history if this applies to you.*

What are your current lifting PRs?*

Coaching Needs
What are your powerlifting goals? Include specific event dates if they apply to you.*
What do you think you need most help with when it comes to your powerlifting and goals? Eg. technique, peaking into a competition, injury management, etc*
Do you have any body composition or body weight related changes you'd also like to make?
Have you faced any specific problems or difficulties when trying to achieve these goals in the past? Please describe.*
What are you looking for in a coach?*
What are you willing to bring to the coaching relationship?*
Are there any other comments/notes you'd like to include which you think are relevant?

Injury / Health History
List and describe current injuries, if any. *
Outline PAST injuries, if any. *
List and describe any health concerns, conditions, or surgeries, if any. *
Thank you for taking the time to complete this form!

Click the submit button and you will be contacted at the next available time slot to discuss your application.
Should be Empty:

Training History