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Contact Information
First Name
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Last Name
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Email
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Application Information
Date of Birth
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Do you have any previous or current injuries? And how do they affect your training?
(Required)
What is your current training level?
(Required)
Beginner (Less than 1 year)
Intermediate (1-3 years)
Advanced (3-5 years)
Advanced+ (5+ years)
What are your 3 main goals at the moment?
(Required)
What are your expectations and what are you hoping to get out of this program?
(Required)
Where did you hear about this program? Why did you choose this program?
(Required)
Do you have a facebook account?
(Required)
Yes
No
No, but I can if needed
Do you consent to Andrew and Bailey using your information for advertising purposes? (ie. social media, instagram)
(Required)
Yes
No
Medical Par-Q
Has your doctor ever told you you have high blood pressure or a heart condition?
(Required)
Yes
No
Do you feel pain in your chest at rest, during your daily activities of living, or when you do physical activity?
(Required)
Yes
No
Do you lose balance because of dizziness or have you lost consciousness in the last 12 months?
(Required)
Yes
No
Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
(Required)
Yes
No
Are you currently taking prescribed medication for a chronic condition?
(Required)
Yes
No
Do you currently (have or have you had within 12 months) a bone, joint or soft tissue (muscle, ligament or tendon) problem that could be made worse by becoming more physically active?
(Required)
Yes
No
Has your doctor ever said that you should only do medically supervised physical activity?
(Required)
Yes
No
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