Train for Life (Republic/Southwest) Registration Form
Train for Life (Republic) is a 12 week Special Olympics Missouri program that focuses on overall wellness. This will be ran out of Crossfit Republic. The address is (509 W State Highway 174, Republic). This program will start on Jan 21- April 9th. There will be a once a week in person fitness component each Wednesday at Crossfit Republic starting at 3:00 PM-4:00 PM. Please see the weekly agenda below: Fitness Workouts•1 x 60 Minute workout in-person with the Train 4 Life™ Coach•2 x 30 Minute at-home workout provided to athletes•. -SIGN UP NOW AS SPOTS WILL BE LIMITED TO 15 Athletes. This is only open to Southwest Area athletes and this is a FREE program! No cost of the athlete.
Athlete Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Athlete Date of Birth:
*
-
Month
-
Day
Year
Date
Athlete Age:
*
Athlete Phone Number
*
Format: (000) 000-0000.
Athlete E-mail
*
example@example.com
Emergency Contact Information: (Guardian/Parent/Relative etc)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Athlete Fitness Goals:
*
Please Select
General Health
Weight Loss
Athletic Perfromance
Competition
Community
Current Fitness Level:
*
Please Select
Beginner (Workout 0-1 time per week)
Moderate (Workout 2-3 times per week)
Advanced (Workout 3-5 times per week)
Injuries/Medical Information Fitness Professional Should be aware of:
*
Athlete Shirt Size
*
Please Select
small
med
large
XL
2XL
3XL
"I acknowledge that participating in fitness activities involves inherent risks, including the potential for injury. I understand that Crossfit Republic is not liable for any injuries or damages that may occur as a result of my participation in workouts or related activities. However, I also recognize that the professionals at Crossfit Republic will do all they can to ensure a safe environment while implementing training."
*
Please Select
I understand.
Submit
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