Expression of Interest
Growfitprogramme
Name
First Name
Last Name
Email
example@example.com
Moblie
-
Phone Number
Address
Street Address
Street Address Line 2
City
Postal / Zip Code
Emergency contact details or Next of kin
First Name
Last Name
Emergency contact number
-
Area Code
Phone Number
What support are you interested in? Eg Full Growfit programme, one to one mentoring etc
What attracted you to the programme
Confidence building
Mindset
Physical movement
Stress awareness
Self care and boundaries
Nutrition Guidance
Balanced lifestyle
Resilience
Where would you put yourself on scale below in your self awareness and self worth
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Growfit programme involves some physical low impact movement and stillness, (which is optional.) Would you like to take part? If so what would you like to take part in? Please can you complete a separate PAR-Q health questionnaire for this.
Dance MOVEMENT (easy dance fitness)
Strength MOVEMENT ( small dumbells and. And weight
Awareness and breathwork ( seated stretch and relax )
Self care, eg massage 💆🏼♀️
Why have you decided to make change to your lifestyle? What are your aims and goals? What have you tried in the past? How is it impacting your life? Please give as much information as possible. This is to see if we can meet your expectations.
Have you ever been affected by any mental health issues that you think may effect you in a group setting ? Eg triggers, ptsd or currently in therapy ?) if yes recommended to check with professional before attending programme (Growfit is not a mental health programme but groups can be unpredictable) if yes, please give details (Optional, don't have to answer
Any other concerns or questions you would like to ask below ?
Submit
Should be Empty: