Super-Soldier Club Application Form

  • Super-Soldier Club Application Form

    Steven Bennett LLC
  • Gender*

  • Part 2. Lifestyle Information

  • Whats the activity level at your job?*
  • How often do you travel?

  • Part 3. Medical and health information

  • Are you experiencing any stresses or motivational problems?*
  • Has anyone of your immediate family developed heart disease before the age of 60?*
  • Do any diseases run in your family?*
  • Do you suffer from diabetes, asthma, high or low blood pressure?*
  • Are you a current cigarette smoker?*
  • Your current diet could be best characterized as:*

  • Part 4. Goals

  • Please rate your readiness for change.*
  • What following goals does best fit in with your goals?*
  • Rows
  • Please rate your motivational level to do what it takes for reach your goal.*
  • Are you currently exercising (at least 3x per week)?
  • Have you trained with a personal trainer before?
  • At what times during the day would you prefer to train?*
  • Format: (000) 000-0000.

  • Please Read The Following Terms and Conditions.

  • 1.) CANCELLATIONS

    Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

    2.) LATE ARRIVALS

    Each session shall be 1 hour in length. Please infom me if you will be running late; I can make adjustments to the schedule. 

    3.) 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!*
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