Online 1:1 Coaching Application Form
All information is confidential and will only be reviewed by KinetoFlex.
Once submitted, Monica will be in contact via email within 3-5 business days regarding the status of your application. The entire application should take about 5-7 minutes. Please be prepared to submit videos & photos of dance technique on the last page.
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Personal Information
Name of Participant
*
First Name
Last Name
Email
*
example@example.com
Age of Participant
*
Time Zone
Participant Social Media Username(s):
© 2024 by KinetoFlex
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Physical Activity Readiness Questionnaire (PAR-Q)
If you have answered YES to one or more of the above questions, consult your physician before engaging in physical activity.
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
*
Yes
No
Do you feel pain in your chest when you perform physical activity?
*
Yes
No
Do you lose your balance because of dizziness, or do you ever lose consciousness?
*
Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
*
Yes
No
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
*
Yes
No
Do you know of any other reason why you should not engage in physical activity?
*
Yes
No
Additional Questions
What is your occupation?
*
Does your occupation require extended periods of sitting?
*
Yes
No
Does your occupation require repetitive movements?
*
Yes
No
Do you partake in any recreational activities?
*
Yes
No
If you answered "yes," what are the recreational activities and how many hours per week?
Have you ever had any injuries or chronic pain? If YES, please explain:
Have you ever had any surgeries? If YES, please explain:
Has a medical doctor ever diagnosed you with a chronic disease, such as a heart disease, hypertension, high cholesterol, or diabetes? If YES, please explain:
Are you currently taking any medication that may impact your ability to exercise? If YES, please explain:
What styles of dance do you do?
*
How long have you been dancing?
*
Do you participate in dance competitions/workshops/auditions?
*
Yes
No
If "no," what kind of performances do you participate in?
Please list 1-5 current goals for your dance season. Please be specific.
*
© 2024 by KinetoFlex
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Custom Meal Plan Information
Please fill out the form with as many details as possible. The more information you provide, the better I can tailor the meal plan to your specific needs, preferences, and goals, ensuring you get the best possible results.
What is your preferred dietary style?
*
Omnivore
Vegetarian
Vegan
Pescatarian
Gluten-Free
Diary-Free
Do you have any food allergies or intolerances?
*
None
Lactose Intolerance
Gluten Intolerance
Nut Allergy
Shellfish Allergy
Other
Do you have any specific foods you enjoy or dislike?
*
What is your primary fitness goal?
*
Weight Loss
Muscle Gain
Performance Improvement
Maintenance
How many meals do you prefer to eat per day?
*
3 meals
3 meals + 1 snack
3 meals + 2 snacks
5 small meals
Other
How much time do you typically have to prepare your meals?
*
15-30 minutes
30-45 minutes
More than 45 minutes
Do you currently track your food intake?
*
Yes
No
Are there any specific challenges or concerns you have related to your diet? (e.g., late-night cravings, emotional eating, etc.)
*
No
Yes, please specify
© 2024 by KinetoFlex
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Technical Analysis
The photos and videos that you may submit in this application form are confidential and deleted upon analysis by Monica. Your information is protected and secure within this database and will not be published or shared with other individuals or organizations.
Please upload a photo/video of you/your dancer doing any dance skill.
*
Browse Files
Drag and drop files here
Choose a file
Examples: splits, leaps, competition photo, leg extension, etc.
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of
Please upload another photo/video of you/your dancer doing a different dance skill.
*
Browse Files
Drag and drop files here
Choose a file
Examples: splits, leaps, competition photo, leg extension, etc.
Cancel
of
What equipment to you have access to? Please check all that applies.
*
Resistance Bands
Yoga Blocks
Weights (dumbbells, kettlebells, etc)
Gym Membership Access
Chair / Bench
Barre
Exercise / Stability Ball
Cardio Equipment (treadmill, bike, elliptical, etc)
Foam Roller
Tennis / Lacrosse Balls
Other Equipment
Do you have any questions or concerns?
By signing below, you acknowledge that the meal plan provided is for nutritional advice only and does not replace professional medical or dietary advice. You agree to consult with a healthcare professional before making any significant changes to your diet, especially if you have specific medical conditions, allergies, or concerns. Additionally, if you experience any injury or discomfort during your training, it is your responsibility to consult with a physiotherapist or healthcare provider. KinetoFlex is not responsible for any injuries or health issues that may arise during the course of your training or diet plan.
*
© 2024 by KinetoFlex
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