Virtual Fitness Inquiry Form

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This form will collect basic health screening information about you to help us guide you to an appropriate program. It includes a registration, pre-screening and liability waiver. We will contact you in person by phone or email to take next steps.

Email *

First Name *

Last Name *

Date of Birth *

YYYY

Phone *

Your preferred method of contact *

Phone

Facebook Messenger

Which Classes/Training is of Interest to you? (All live virtual classes are recorded so you can participate at any time) *

7@7 - (7am) 10 min workout daily Mon - Fri

6am HIIT for 50+ 30 min workout Mon/Weds/Fri

9:30 am Tai Chi-Qi Gong Mon/Weds/Fri

Virtual Personal Training

In - Person Training

Integrative/Functional Movement Coaching

Other:

Required

Newsletter sign-up

Yes

I already get your newsletter

Please add me to the email subscription list for the newsletter and fitness tips (no spam - and you can unsubscribe at anytime)

Clear selection

Participant Activity Readiness Pre-Screening:

Please note that these questions are very general and we do not require details at this stage. If you have answered YES to one or more of the questions below, we will contact you for more details. In some cases you may need to get medical clearance to take part in this exercise program. The information will not be shared with anyone.

Please answer either YES or NO to the following *

YES

Has your doctor told you that you have a heart condition?

Do you have high blood pressure ?

Do you get chest pain at rest, daily activity OR exercise ?

Do you suffer from dizziness (except when caused by overexertion) ?

Have you been diagnosed with a chronic medical condition ?

Do you have a bone or joint problem that could be made worse by exercise ?

Has your doctor told you that you should only participate in medically supervised physical activity

YES

Has your doctor told you that you have a heart condition?

Do you have high blood pressure ?

Do you get chest pain at rest, daily activity OR exercise ?

Do you suffer from dizziness (except when caused by overexertion) ?

Have you been diagnosed with a chronic medical condition ?

Do you have a bone or joint problem that could be made worse by exercise ?

Has your doctor told you that you should only participate in medically supervised physical activity

Risk and Liabilility Waiver

Upon acceptance into this program a more detailed Health Screening and Liability Waiver will be sent to you.

As a participant in this program please be aware that it is your responsibility to provide the following: *

Agree

Disagree

I have a safe space to workout in approx 10' x 10'

I will ensure that I have enough space above head

I will check that any equipment I use is safe, stable and secure

It is my responsibility to select appropriate footwear

It is my responsibility to hydrate as needed

Participating while unwell or with minor injury is not recommended, however I understand that it is my choice and I will listen to my body and adjust the intensity accordingly

I understand that I will not be receiving individual coaching during this class

I will request a coaching session if I require individual help regarding correct form if I am unsure

Exercising and moving your body should not be painful! If I experience discomfort I will message for help

I have adequate connection to the internet

Agree

Disagree

I have a safe space to workout in approx 10' x 10'

I will ensure that I have enough space above head

I will check that any equipment I use is safe, stable and secure

It is my responsibility to select appropriate footwear

It is my responsibility to hydrate as needed

Participating while unwell or with minor injury is not recommended, however I understand that it is my choice and I will listen to my body and adjust the intensity accordingly

I understand that I will not be receiving individual coaching during this class

I will request a coaching session if I require individual help regarding correct form if I am unsure

Exercising and moving your body should not be painful! If I experience discomfort I will message for help

I have adequate connection to the internet

A copy of your responses will be emailed to the address you provided.

Submit

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