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.
Please note: You will need to list your available days and times in the application. You will be contacted if one of those times work for Monica, or an alternative day/time will be proposed.
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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?
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Yes
No
Do you feel pain in your chest when you perform physical activity?
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Yes
No
Do you lose your balance because of dizziness, or do you ever lose consciousness?
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Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
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Yes
No
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
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Yes
No
Do you know of any other reason why you should not engage in physical activity?
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Yes
No
Additional Questions
What is your occupation?
*
Does your occupation require extended periods of sitting?
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Yes
No
Does your occupation require repetitive movements?
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Yes
No
Do you partake in any recreational activities?
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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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Training Session Information
Are you willing to commit to a 50 minute training session at least 1 x per week?
*
Yes
No
Are you willing to follow the business policies of KinetoFlex including a 24 hour cancellation policy for any cancellations, no-shows, and reschedules & a 30-day subscription cancellation notice?
*
Yes
No
Are you willing to invest $500 per month for a monthly training plan, weekly training sessions & check-ins for a commitment of at least 3 months?
*
Yes
No
What fitness equipment do you currently have access to? Check all that apply. Please note that resistance bands are the minimum equipment requirement to start training.
*
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
Please indicate specific available slots in your schedule including the day/time/time zone. Please note that you will be notified via email when new time slots become available.
Please include exact days, times, and time zone. Be as specific as possible.
How did you hear about us?
*
Instagram
Tiktok
Friend/colleague
Email Lists
Pinterest
Other
If you were referred by a friend, write their name below!
© 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.
Cancel
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
Do you have any questions or concerns?
By signing below, you acknowledge that the training plan provided is for fitness guidance only and does not replace professional medical or physical therapy advice. You agree to consult with a healthcare professional before starting any new exercise program, especially if you have existing medical conditions or concerns. Additionally, if you experience any injury or discomfort during your training, it is your responsibility to seek advice from a physiotherapist or healthcare provider. I am not responsible for any injuries or health issues that may arise from following the training plan.
*
© 2024 by KinetoFlex
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