5AM Active Club
Welcome, we’re excited to have you take the first step toward a stronger, healthier, and more disciplined you. This quick form helps us understand your fitness level, goals, and any important details so we can deliver the best possible training experience.Let’s get you set up and ready to start your 5AM journey. 💪🏾
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions
*
Yes
No
If yes, please explain
Relationship Status
Please Select
Single
Married
Widowed
Fitness Goals
What would you like to achieve with us?(check all that apply)
*
I want to lose weight and tone up for a healthier weight
I'm ready to regain my energy & vitality
I want to feel stronger and more confident in my body
I'm recovering from an injury and need expert guidance.
Something else? (Tell us more)
What’s one fitness milestone you’ve always dreamed of achieving?(This helps us understand what drives you.)
*
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Lifestyle Assessment
How would you describe your eating habits
*
Balanced and Healthy
Mostly Healthy
Inconsistent
Unhealthy
How many hours of sleep do you get nightly?
*
Less than 5 hours
6-7 hours
5-6 hours
7+ hours
How often do you feel stressed?
*
Rarely
Sometimes
Often
How active are you currently?
*
Light Activity
High Activity
Moderate Activity
No Activity
When was the last time you have participated in physical fitness programs?
*
1 month ago
2 months ago
N/A
Other
Have you worked with a personal trainer before?
*
Yea
No
Do you smoke?
*
Yes
No
Do you drink?
*
Yes
No
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Medical Information
Any allergic reaction to medicines (e.g. aspirin, penicillin, etc.)?
*
Are you currently taking any prescribed medications?
*
Do I you have any physical injuries?
*
Did you have any recent illnesses or hospitalizations?
*
Any allergic reaction to food?
*
Do you have Diabetes?
*
Please Select
Yes
No
Have you had any operation in the last two years?
Please Select
Yes
No
Please specify, which operation have you had?
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Acknowledgement & Waiver
By checking this field and submitting this form I hereby conform to the terms and conditions hereunder
I understand that participation in fitness activities at Active Fitness Club is voluntary and that all programs are designed with my safety and wellness in mind. I accept full responsibility for my participation and release Active Fitness Club and its staff from any liability arising from injuries or health concerns.
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