Vibrant Living

1:1 Coaching Application Form

(approx. 2 mins to complete)
Full Name*

First NameLast Name
Gender

MaleFemaleOther
Date of Birth*

DayMonthYear
Height*
Feet & Inches (i.e. 5'9)
Weight*
KG
Job?
Work Schedule?
Do you have set days, shifts, times etc
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Instagram Handle?
Email*
example@example.com
Activity/Fitness level?*

Sedentary (little to no movement or exercise)Light activity/exercise (low intensity exercise 1-2 times per week)Moderate activity/exercise (moderate intensity exercise 3-4 times per week)Heavy activity/exercise (moderate-intense exercise 5-6 times per week)Very heavy activity/exercise (vigorous work/exercise 6-7 times per week)
On average, how many steps do you take per day?*

1k-3k3k-6k6k-9k9k-12k12k+
Training Experience?*

Beginner (0-6 months experience)Intermediate (6 months - 2 years experience)Advanced (2+ years experience)
Training Goals?*

Weight/Muscle GainFat LossBetter Habits/DisciplineSelf-Esteem/ConfidenceGeneral Health & WellbeingOther (Please Specify)
Have you ever had a personal trainer/coach before?

YesNo
Any major current or prior injuries that I should be aware of? (say no if not)*
Please list what it is/was and when did it happen?
Have or are you taking additional therapies for the given injury?
rehabilitation, physiotherapy, massage etc.
Any previous or upcoming surgeries that might affect your training ability? (say no if not)*
i.e. ACL, meniscus, rotator cuff etc.
Any further medical conditions? If yes, please list them*
'No' if you do not have any medical conditions.
Do you suffer from diabetes, asthma, high or low blood pressure?*

YesNo
Are you an active smoker (cigarettes or vapes)?

YesNo
Alcohol?

Almost never (on special occasions)Often (once a month)Infrequently (once every two weeks)Regularly (one or more days a week)
Dietary Needs/Preferences?*

No Special Dietary RequirementsVegetarianVeganLactose IntolerantGluten-FreeOther (Please Specify)
How many days a week would you be willing to train? (be reasonable)*

2-33-44-55-6
What type of workouts do you prefer? (Select all that apply)*

Weight TrainingHyrox/TrykaCardiovascular
Additional Information: Is there anything else you'd like us to know?
(Terms & Conditions)

I confirm that all information provided in this application form is accurate to the best of my knowledge. I will promptly inform my trainer of any changes to my health status or medical conditions that may affect my ability to participate in physical activities.

I understand that my coach will work with me to create a personalized program based on my goals, preferences, and fitness level.

I agree to abide by the payment and cancellation policies for online coaching services.

I understand that any personal information or health-related details shared with my trainer will be kept confidential and only used for the purpose of creating a safe and effective training plan.

By signing below, I confirm that I have read, understood, and agree to the terms outlined in this agreement. I acknowledge that I am voluntarily entering into this agreement and assume full responsibility for my participation.
*

I AGREE TO THE ABOVE TERMS & CONDITIONS!
Should be Empty:

1:1 Coaching Application Form