WARRIOR WOMEN ONLINE COACHING APPLICATION FORM
Sign in to Google to save your progress. Learn more
What is your Full Name? *
What is your Date of Birth? *
MM
/
DD
/
YYYY
What is your Gender? *
What City / State / Country are you located in? *
Best Contact number: *
Email address *
What is your Occupation? *
What is your Date of Birth? *
What is your height? (cm)
Wha is your current weight? (kg)
What is your main Goal that you would like me to help you with? *
Required
If Weight loss is one of your goals, roughly how much weight do you want to lose? (In kilograms) 

If Weight Gain is your goal, how much do you want to gain? (kg)
 How long are you willing to commit to working towards your goals? *
How many days per week can you commit to a training/exercise routine?  *
How much time can you commit to / would prefer to exercise each day?  *
What are you willing to spend per week on Coaching?  *
Required
Do you have any current or past injuries that could affect your training? Please give details. *
Do you have any current Medical Conditions? Please select or share any relevant details: *
Do you have any dietary requirements/preferences/allergies? *
Are you willing to take physical measurements including weight, waist & body circumference, & progress photos to keep track of your progress? *
Are you wanting to train from home, from a gym, and/or what equipment do you have access to? *
Required
What kind of guidance, if any, would you like with your Nutrition? Please tick all that apply. *
Required
What is your dieting history? Have you followed any specific diets, meal plans, or calorie restrictions in the past? Please give details. *
What is your current exercise routine, if any? How many days per week do you currently exercise and what do you do? *
Describe your Exercise History - what types of sport or exercise have you done in the past, at what level (eg. beginner/intermediate/athlete) and how long for? *
Have you previously had a Personal Trainer or completed an online fitness/nutrition program before? *
Are there any specific movements, exercises or specific body areas to target that you would specifically like to learn from me?
Do you have any other questions, comments or feedback for me:
TERMS & CONDITIONS

Cancellation Policy: No cancellations during initial 12 weeks. If during the initial 12 weeks a medical issue arises, a doctors certificate is required to request a hold or cancellation upon special circumstances. After this time at least 2 weeks notice given via email to info.ilukafitness@gmail.com for cancellations.
 
Freezing/Holds: No holds available for initial 12 weeks; after this time you can postpone your membership for up to 4 weeks; with at least 2 weeks notice via email to info.ilukafitness@gmail.com

Refunds: Upfront payments are non-refundable. Direct debits are non-refundable unless mistakenly charged. Future payments can be paused or stopped upon written request compliant with cancellation/hold policies.

Direct Debit: Direct Debits will come out weekly unless requested otherwise. Payments will continue for the initial 12 weeks; then after discussion with myself they will be stopped unless you agree to continue onto an ongoing membership. Nothing will come out of your account after the 12 weeks unless agreed by you. If you wish to continue, payments will continue in the same manner or adjusted to another schedule or package as decided by you.

Waiver: Whilst participating in this program, you understand that my coaching is not medical advice and you participate at your own risk. I am a qualified Personal Trainer but am not a qualified Physiotherapist , Exercise Physiologist  or GP – nor a fully qualified Nutritionist/Dietician. As much as I will endeavour to prevent any injuries or harm to my clients, any injuries that result due to following my program will be acknowledged as an anticipated possibility and taken as one’s own responsibility.
Results are NOT guaranteed – if you follow the program 100%, you are 95% likely to get great results – however many other external factors can contribute and generally progress takes longer than anticipated, and depending on your body type, age, genetics, history, medical conditions, injuries etc. If you have not complied with the program completely, no responsibility is taken from my part for lack of progress on your part.
If you have any further questions regarding this contract, please email me at info.ilukafitness@gmail.com 
THANKYOU for completing this questionnaire! Please follow this link to book in your 15-minute Free Strategy Call with me so we can discuss your goals and see if we are a good fit for each other, and work out a game plan to help you reach your goals!                                                               https://calendly.com/info-ilukafitness/iluka-fitness-consult
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
Google Forms