Pro 11 Coaching Declaration Form

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Age

years

Height

cm

Weight

KG

Email address

example@example.com

Phone number

What do you do for a living?

Whats the activity level at your job?

Please list the physical activities that you participate in outside of exercising and outside of work. i.e. Hobbies, etc.

Do you have any medical conditions?

If you are on any medications, please list them.

Do you have any current or previous injuries that would stop you exercising?

Has anyone of your immediate family developed heart disease before the age of 60?

If yes please give more information on this

Do you suffer from diabetes, asthma, high or low blood pressure?

if yes please list:

Are you a current cigarette smoker?

How often do you drink alcohol

Your current diet could be best characterized as:

What following goals best fit in with your goals?

Other goals

Why?

Timeline for achieving your goal.

Rows	4 WKS	8 WKS	12 WKS	24 WKS	32 WKS	1 YEAR	Long term lifestyle change
NOW

Are you currently exercising regularly?

Are you currently a member of a gym facility?

If yes please state which one and how often you use it?

In your words please tell me about yourself and your personality along with any physical or mental aspects you would like to work on?

1.) COMMITMENT - I agree that i will fully commit to my plan and all elements that come with it including daily commitment to creating a better lifestyle and future for myself, this will include committing to better nutrition, commitment to regular exercise, tracking my statistics set through this plan and also my check-ins throughout the plan. 2.) RESULTS - I understand that to fully receive the benefits of this plan i need to fulfil my committment to it and take responsibility for my actions which will ultimately show in my results. 3.) PLAN COURSE - I understand that this journey will not be easy, it will not be progression all the time and there will be set backs which i will accept and work on to help continue the overall progression of the plan and my goals. 4) TRAINING LIABILITY - I understand that any training i do whether 1-2-1, Group Training or Online training is my full responsibility and liability including any injury, illness or medical condition that may come from this, I hereby revoke Pro 11 Coaching and David McCracken of all liability with any of these matters and have no rights to make claim against them on these matters. 5.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT - All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

I AGREE TO THE ABOVE TERMS & CONDITIONS!

YOUR TRAINER.....

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4. Goals

Please Read The Following Terms and Conditions.