DRIVEN RISE
Personal details
Name
*
First Name
Last Name
Date of birth
-
Day
-
Month
Year
Date
Phone Number
Please enter a valid phone number.
Format: 0000 000 000.
Email
example@example.com
Choose your Path
Please Select
Perform
Transform
Unsure - id like a coach to help me choose
Payment option
Please Select
$15pw added to my direct debit
$180 UPFRONT (Due on 26.07.26)
Please note direct debit payments
What day would you like to come in for initial assessment
Please Select
Saturday (9am - 12pm)
Sunday (9am - 12pm)
Signature
*
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YOUR GOALS
Why have you decided to join the 12-week Rise challenge?
What are your top 3 goals for the next 12-weeks?
1
2
3
At the end of the challenge, what would success look like for you?
How confident do you feel in achieving your goals over the next 12-weeks
Not at all
1
2
3
4
I've got this
5
1 is Not at all , 5 is I've got this
What do you think will be your biggest challenge over the next 12-weeks?
What areas do you believe you will struggle most in?
Rows
Nope, I'm good
Somewhat
Yes, I need lots of help
Training
Nutrition
Recovery
Habits
Health and wellness
Has anything changed regarding your health since completing your gym membership paperwork?
No
Yes
If yes, please give detail.
Do you have any current injuries or limitations that our coaches should be aware of?
Are you currently pregnant or given birth in the last 6 months?
I am pregnant
I have given birth
Neither
Progress tracking
To help us measure your progress throughout the challenge, we may record:
Body measurements
Progress photos
Weight (where appropriate)
Fitness testing
I understand and agree to participate in progress tracking
yes
Commitment
I am committed to:
Attending my scheduled training sessions.
Giving my best effort throughout the challenge.
Communicating with my coach if I need support.
Respecting fellow members and coaches.
Staying consistent, even when motivation is low.
I understand that my results will reflect the effort and consistency I put into the challenge.
yes
Media consent
Throughout the challenge we'll be celebrating member achievements.
May we use your photos, videos and challenge success story in future marketing?
Yes for sure
Yes but please show/ask me before posting
No, id prefer to remain private
Is there anything else you would like our coaches to know?
Signature
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