Training_PreQual

Full Name*

First NameLast Name

Sex

MaleFemale

Date of Birth*

MonthDayYear

Age*

years

Height*

Ft. In.

Weight*

LBS

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number*

Area CodePhone Number

What do you do for a living?*

Please rate the activity level at your job?*

none (seated only)Moderate (light activity such as walking)High (heavy labor, very active)Varies Daily

Are you a student?*

YesNo

Are you an active, reservist, or veteran of the United States military?*

YesNo

Do you follow a regular working schedule, do you work days, afternoon or nights?*

How often do you travel?*

RarelyA few times a yearA few times a monthWeekly

Please list the physical activities that you participate in outside of the gym and outside of work:

Are you prepared to invest in yourself and be patient as you work towards your goals?*

YesNo

If you have any diagnosed health problems, list the condition(s).

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

Are you experiencing any stresses or motivational problems?*

YesNo

If so, please explain

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

YesNo

Do any diseases run in your family?

YesNo

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

YesNo

If so, please list:

Are you/will you be cleared by a medical professional to start a new training regimen or make the personal choice not to consult with a medical professional?*

YesNo

Do you smoke, or vape?*

Yes, frequentlyYes, infrequentlyNo

Your current nutrition habits could be best characterized as:*

Rate the quality of your nutrition habits 1-10*

Please rate your readiness for change.*

What best characterizes your goal(s):*

What is your overall goal?*

Why?*

Construct a goal utilizing the S.M.A.R.T system (Specific, Measurable, Attainable, Relevant, Time-Based) for 12 months, 6 months, 3 months, and 1 month. *

Take your time. Be SMART

How often are you willing to train per week to reach your goals?*

Please rate your "motivational" level to do what it takes to reach your goal.*

Rate the intensity level of your ideal workout 1-10*

Are you currently exercising regularly (at least 3x per week)?*

YesNo

Have you trained with a personal trainer before?*

YesNo

If yes what kind of training did you do and why did you stop?

At what times during the day would you prefer to train?*

MorningMid-DayAfternoonEvening

How often do you want to train with your coach per week?*

Please Choose

What are your expectations for your coach?*

Firearm instruction is an integrated aspect of EBG Training packages. This instruction will be scaffolded to YOUR skill level. Are you willing to take part in firearm instruction as a part of your program? *

Yes or No

Rate your Experience with Firearms 1-10*

Do you have a CPL (Concealed Pistol License)*

YesNo

If not, are you eligible to get one? (age, criminal record, etc.)*

What questions do you have for us?

If accepted for the program, what date would you like to start?*

Date

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. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client. 3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT All the information on this form is correct and to the best of my knowledge. 4.) I have sought and followed any necessary medical advice before beginning a new or altered training regimen. 5.) I understand that the submission of this form does not guarantee admission to the EBG Training Program and that an in-person consultation or, if applying for online coaching, a video conference will be necessary. 6.) I understand that is my own responsibility to make the decisions necessary to see my own elevation as a person, and my coach as well as EBG Training are not guaranteeing any result--but they are guaranteeing an opportunity to learn and improve towards an elevated version of myself.

I understand that all the information given will be kept confidential.

I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo

Signature

Health History

Day-to-Day and Goal-Setting

Fitness

Firearm Instruction

Finalizing