Desired Physique Registration Form

Registration Form

Enter your details below and I'll send you more details within 48 hours.
Which program are you interested in?*
Full Name*

First NameLast Name
Date of Birth

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Date
Sex:
Phone Number*
Email
example@example.com
Full Name of Emergency Contact*
Phone Number of Emergency Contact*
Instagram Handle
Facebook Name
How did you hear about us?*
Do you have any existing medical issues? If yes, please explain.
I volunteer to participate in the Online/ Personal/ Group/ Home Training conducted by Desired Physique. I understand that the program can be physically demanding and may lead to physical injury. I understand that it is my responsibility to consult with a physician prior to my participation in any exercise or form of physical activity and confirm that I am medically fit and in good enough health to participate in any training sessions done by the Desired Physique team. I take full responsibility for the risks I am exposed to and accept full responsibility for any injuiries that you receive while training with Desired Physique.*

I agree
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