12 Month- Revive 2026: Rebuild the Temple, Renew the Mind

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Participant Full Name* This field is required.
First Name
Last Name
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Participant E-mail* This field is required.
example@example.com
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Participant Phone Number* This field is required.
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Emergency Contact* This field is required.In case of emergency at any of the events.
First Name
Last Name
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Emergency Contact Phone Number* This field is required.
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Occupation* This field is required.Specifically list if you have a medical background
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What is your fitness goal?* This field is required.
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What topics are you most interested in learning?* This field is required.
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What are your biggest struggle with maintain a health diet * This field is required.
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Days of the week best for 1-hr zoom calls (1x per month)* This field is required.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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I am currently getting at least 150 minutes of physical activity each week* This field is required.2= disagree 3= Neutral 4= Agree
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Strongly Agree
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I feel confident using basic exercise movements (e.g., squats, lunges, push-ups)* This field is required.2= disagree 3= Neutral 4= Agree
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I understand the difference between strength training and cardio and include both* This field is required.2= disagree 3= Neutral 4= Agree
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Strongly Agree
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My energy levels stay consistent throughout the day* This field is required.2= disagree 3= Neutral 4= Agree
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Strongly Agree
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I eat balanced meals that include protein, healthy carbs, and fats* This field is required.2= disagree 3= Neutral 4= Agree
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I drink enough water daily (about 64–80 oz or more)* This field is required.2= disagree 3= Neutral 4= Agree
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Strongly Agree
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I limit processed foods, sugar, and fast food most of the time* This field is required.2= disagree 3= Neutral 4= Agree
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I understand portion control and what’s appropriate for my goals* This field is required.2= disagree 3= Neutral 4= Agree
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I have a clear reason or “why” behind wanting to improve my health* This field is required.2= disagree 3= Neutral 4= Agree
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I feel motivated and disciplined even when results are slow* This field is required.2= disagree 3= Neutral 4= Agree
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I’m open to learning and trying new approaches to improve my health* This field is required.2= disagree 3= Neutral 4= Agree
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Strongly Agree
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Please type "NO Medical Clearance Required" OR "Need medical release form" to acknowledge. I have been cleared medically to participate in physical exercise OR I am pending medical evaluation to start a new fitness routine* This field is required.
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Download this form and return prior to completing your first workout. Not needed for classes.
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How do you prefer to receive encouragement or accountability? (e.g., group chat, private check-ins, challenges, journaling)* This field is required.
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Please type "UNDERSTAND" to acknowledge. Most classes and workouts will be held on Saturday mornings and last anywhere from 60min-120 min depending on the day.* This field is required.
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SignatureThis Signature confirms your registration! Look forward to meeting you at kick off!
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