Boot Camp Application Questionnaire

Name: Date of Birth:
Address:

City State Zip:

Mobile Phone Home Phone

Email

 Height WeightGender

Today's Date

Body type  Thin Medium Stocky   Body shape athletic apple pear spare tire only
 
How did you find us? (Search engine, daily deal site, yelp, facebook, etc.

Purchasing (check one or more):
  1. Outdoor Boot Camp
  2. Indoor Group Personal Training
  3. Personal Training
  4. Custom Designed Nutritional Program (optional, additional fee)                

1. Do you have any health condition that would put you at risk while following an exercise program or strict diet (such as diabetes, high blood pressure, heart condition, pregnancy, etc.)?

Yes No If yes, please name condition(s): If yes, we will require a note from your physician.

2. Do you have any injuries, past or present, which could possibly impact your ability to exercise?

Yes No  If yes, please explain:

 3. What do you want the product of your training to be (ex.: a beautiful physique, greater health and vitality, fun workouts, etc.)?

Why?

4. On a scale of 1 to 10 , rate your commitment to the goal of achieving the body of your dreams:   

5. Last regular exercise was months ago. How often?What do / did you do?

6. What is the amount of time in days and hours that you are willing to commit to physical training?:

7. How often do you normally involve yourself in aerobic activity?

8. What is your favorite form of aerobic activity:

9. How often do you train with weights and for how long?

10. How many calories do you think you consume in a normal day?

11. How many meals do you eat in a normal day?

12. Do you feel hot or cold often? Yes No

13. Are your hands or feet cold often? Yes No

14. Are you lactose intolerant?  Yes No If yes, with what severity? Please describe:

 15. Do you suffer from poor digestion or gas?  Yes No If yes, when?

 16. Please specify your goals :  Gain muscle # pounds:     Lose fat   # pounds: 

17. Have you worked with another trainer or boot camp program before?  Yes No If yes, please list name and locations:

Please add any special info about you or your goals you think we may need :

18.  If you are ordering a nutritional program, Please list everything you have eaten for the past two days:

 Yesterday:                                          

        

 Day before:

19. Do you commit to following the advice of your trainer completely? Yes No

The above information is accurate and complete to the best of my knowledge and belief.      Yes No

Please send a "before" photo attached to a separate email to: jasonk@smpersonaltraining.com (optional)

  
 Click submit once,