Stimulus Scholarship Membership Application

CrossFit Stimulus believes that everyone deserves an opportunity to succeed at every level of their lives. For that reason, we launched our “Stimulus Scholarship” program, whose mission is to make CrossFit more accessible to the underserved communities in Hampton Roads, and to increase diversity in our CrossFit community.

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Name: *
Mobile Phone: *
Email: *
Address: (Please include city, state, and zip) *
Date Of Birth *
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Have you been a member of a CrossFit gym before? If so, how long and where did you attend?
Which class time below best suits your schedule for the first 2 weeks of your program? (After the first 2 weeks you will no longer have a set schedule and can choose from our 55 class times available weekly) *
Will you be in need our free childcare services during your workouts? *
Have you been on a regular exercise program in the last 6 months?
Clear selection
What are your current fitness goals? Please check all that apply.
Over the past 10 years how many times have you started and stopped a nutrition or exercise program?
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In your own opinion, why did you fail to "stick with it"?
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What external factors have derailed your progress in the past?
Clear selection
On a scale of 1-10 how serious are you about achieving your goals?
Not serious at all
Very serious
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How much, if anything, would you be able to contribute monthly towards your membership? *
Would the financial assistance be temporary? If so, approximately how many months?  *
Are you willing to commit to attending an average of AT LEAST 3X/WEEK FOR AT LEAST 6 MONTHS while on scholarship and participate in quarterly goal review sessions?  (Please note, this is a requirement to participate in this program)
 *
Please tell us why you think you'd be a good fit for the program, what it would mean to you, etc.? *
We will contact you within 10 business days as to whether we have any Scholarship openings and any next steps that may be available. 
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