Welcome to the 60-Day New Year's Challenge

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

To participate in the challenge, answer the questions below. I'll then be in contact soon with more information and instructions on how to submit payment, join the online community and more. I look forward to working with you!

Your name *

Your email address *

Will a friend be joining you in the challenge for free? If so, please add your friend's name and email address.

What are your goals for the New Year?

Losing weight

Getting stronger

Creating better habits

Increased conditioning

Eat better

Tackling an event (ie. a 5K or 10K, Spartan Race or Tough Mudder, etc.)

Other:

How would you describe your current fitness level/experience?

I am a beginner who has never been active; very little or no experience exercising

I am a beginner who has tried to be active and exercise in the past, but hasn't been able to make it stick

I used to be active, but have gotten out of shape because of a lack of time and/or bad habits

I have occasionally done well and been active and fit, but then I backslide and get out of the habit

I've done okay being active and fit, but I'd like to do better and/or be more consistent

I'm relatively fit and I exercise, but I'd like to improve by performance/fitness

I'm very active and fit, and I'm looking to maintain or improve by performance/ability/fitness

Clear selection

What are the biggest pitfalls/obstacles you struggle with when you try to get fit?

What do you currently do for fitness?

Where do you workout?

Gym

Home

Both

Other:

Clear selection

Which of the following are barriers/obstacles that are currently holding you back from achieving your fitness goals?

Lack of time

Poor nutrition

Low energy

Lack of motivation

Not knowing what to do

Other:

Do you have any injuries or health issues I should know about that might impact your ability to exercise? (Always consult a doctor before beginning any fitness program.)

Is there anything else you think I should know about you?

Do you have any questions for me?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms