3 Month Progressive Strength + Conditioning Hybrid Program @ HOME or GYM with Kayla Limpright

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Full Name* This field is required.

First Name

Last Name

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Date* This field is required.

Date

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Email Address* This field is required.

example@example.com

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Age* This field is required.

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What are your fitness/ lifestyle/ physical goals?* This field is required.Weight loss, muscle gain, endurance, know what I'm doing in the gym, fit in my jeans, love what I see in the mirror, etc.

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I understand and acknowledge that the 3 Month Progressive Strength + Conditioning Hybrid Program is to be done on my own time and is best suited in a fully equipped public gym.* This field is required.For 1-1 coaching, whether that be in-person, online or a mix of both, please fill out my other form in my bio on Instagram or message me directly.

I acknowledge and understand

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I acknowledge that the Progressive Strength + Conditioning Hybrid Program is for my own personal use only and cannot be sold, posted online, or shared with others. I also understand that I have full access to the program once payment has been received via the Trainerize app for one full calendar year from the payment date.* This field is required.

I acknowledge and understand

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Has your doctor ever said that you have a heart condition OR high blood pressure?* This field is required.

YESNO

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Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?* This field is required.

YESNO

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Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?* This field is required.

YESNO

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Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?* This field is required.

YESNO

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Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active?* This field is required.

YESNO

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Has your doctor ever said that you should only do medically supervised physical activity?* This field is required.

YESNO

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I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that Kayla Limpright may retain a copy of this form for her records.* This field is required.

Yes

No

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Digital Signature* This field is required.

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Please select one of the payment options below:* This field is required.$150.00 one time payment

E-transfer: kayla.limpright@gmail.com

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