Champs Fit Den Intake Form

Champs Fit Den Intake Form

Your Information
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Height
cm
Weight
kg
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any diagnosed health problems?
Are you taking any medications? If yes, please list below.
Do you have any injuries? If yes, please list below.
Have you been cleared by a physician to exercise?
What are your primary fitness goals?
Which program are you interested in enrolling in?
Current exercise frequency
How would you describe your nutrition currently?
Are you interested in suggestive meal guidance?
Preferred method of communication:
Please rate your readiness to change.

1

2

3

4

5

1 is Worst, 5 is Best

Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Training Policies & Acknowledgment

Please read and acknowledge the following:

Champion Made Fitness provides exercise and wellness guidance only and does not offer medical or clinical nutrition services.
Sessions are scheduled in advance and are expected to be attended on time.
Missed sessions due to client mishap (including oversleeping, scheduling conflicts, transportation issues, or last-minute cancellations) are not guaranteed to be made up.
Make-up sessions may be offered only if space is available, must be approved in advance, and must fall within open session availability.
Make-up sessions are not guaranteed and must be completed within the active training period.
By signing below, I acknowledge that I am voluntarily participating in fitness training and understand the risks associated with physical activity. I agree to follow all training policies outlined above.
Signature
Date

MonthDayYear
Date
Should be Empty: