Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Preferred method of contact

phone

email

both

Which program interests you? *

Online training

Training at the academy

Competition prep

Are you currently taking medications? *

yes

no

Please select if you have had any of the following conditions *

heart attack

stroke

chest pain

hypertension

diabetes

cancer

high cholesterol

hernia

arthritis

anemia

other

none

Please select if you have ever been injured in any of the following areas *

neck

shoulders

arms

abdomen

back

legs

none

Have you had any surgeries of any kind? *

yes

no

Have you had any children? *

yes

no

Are you currently under the care of a physician for any reason at all? *

yes

no

Do you smoke cigarettes or consume any kind of recreational drugs? *

yes

no

Do you drink alcohol? *

yes

no

Do you sleep at least 7-8 hours a day? *

yes

no

Has your doctor given you any restrictions for your exercise program? *

yes

no

Are you currently involved in regular cardiovascular exercise? *

yes

no

Are you currently involved in regular strength building exercise? *

yes

no

Do you eat breakfast? *

yes

no

Do you eat within 2 hours of bedtime? *

yes

no

Do you snack during the day? *

yes

no

Do you have low energy levels during the day? *

yes

no

Are you familiar with all the items on a food label? *

yes

no

Do you take any vitamins or supplements? *

yes

no