Charlie Mallon Coaching Online Enquiry Form
Takes a 5-10 minutes to complete
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Instagram handle
Height
Weight
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What are your Goals?
Any existing medical conditions?
PAR-Q + Injury History
Current/past injuries- or any pain your currently dealing with
Any medications/supplements you are taking
I confirm my answers above are fully transparent and complete, I understand that exercise carries an inherent risk & I accept full responsibility for taking part in this coaching program. Charlie Mallon is not responsible for any injuries or harm resulting from my participation.
Yes I confirm
What exercises are your favourite and what exercises are your worst nightmare 😂
How many days a week can you/like to train?
How much time in the day do you have to train?
I agree that coaching is a 12-week minimum commitment- results take time and consistency, time is needed for both of us to give this our best effort, this service has your best interests at mind always.
I agree
I understand all payments are non-refundable; however if I need to pause for genuine reasons such as medical or unforeseen personal circumstances then I will speak directly to Charlie about this
I agree
Today's date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
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Continue
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