Fitness Transformation Release Form
Please complete this form to provide your information and consent for participation in the fitness transformation program.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Do you have any current or previous medical conditions? If yes, please specify.
*
Are you currently taking any medications? If yes, please list them.
Do you have any injuries or physical limitations? If yes, please describe.
What are your primary fitness goals? (Select all that apply)
*
Weight loss
Muscle gain
Improved endurance
Increased flexibility
General health and wellness
Other
How would you describe your current activity level?
*
Sedentary (little or no exercise)
Lightly active (light exercise 1-3 days/week)
Moderately active (moderate exercise 3-5 days/week)
Very active (hard exercise 6-7 days/week)
Other
Please list any allergies or dietary restrictions.
Participant Signature
*
Submit
Submit
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