Coaching Application
This application form is for Online Powerlifting Coaching. If you're interested in 1:1 in-person private sessions, direct message @jacoblifts_ on instagram.
Contact Details
Initial contact will be through WhatsApp or E-mail.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
What country do you reside in?
*
Social Media Handle (Instagram, TikTok...)
Powerlifting Coaching
How long have you been training for? (recreationally and competitively)
*
Would we be prepping for a powerlifting competition? If yes, when?
*
What weight class are you in?
*
Please Select
M 52KG
M 59KG
M 66KG
M 74KG
M 83KG
M 93KG
M 105KG
M 120KG
M 120+KG
F 47KG
F 52KG
F 57KG
F 63KG
F 69KG
F 76KG
F 84KG
F 84+KG
What is your best competition total? (Leave blank if you've never competed)
Have you worked with a powerlifting coach previously?
Yes
No
What age category are you in?
*
SUB-JR (u16)
SUB-JR (u18)
JR (u23)
OPEN (23-40)
MASTERS 1-4 (40+)
Final Questions
What is your DOB?
*
-
Month
-
Day
Year
Date
Do you partake in any other sports alongside Powerlifting?
*
If we decide to work together, when would be your preferred start date?
*
-
Month
-
Day
Year
Date
Thank you for filling out the application form, contact will be made either via WhatsApp or E-mail to book in a Zoom video call consultation.
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