Ninja Strong Virtual Bootcamp Registration Form
I'm so excited to have you for Virtual Group Training! PLEASE READ ALL QUESTIONS especially the last one which is the liability waiver. Then you will receive a receipt of submission of the form. All answers are kept confidential and I will contact you directly if I need additional information. Payment is due after completion of this form.
Email *
Name *
Phone Number *
Address *
Date of Birth *
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Emergency Contact Name and Phone Number *
What are your health and fitness goals for this program? *
ex. lose weight, tone, more energy, stay on track, be healthier
Does your occupation require extended periods of sitting? *
Does your occupation require repetitive movements? If yes, explain. *
Does your occupation require heavy lifting? *
Do you currently workout or just starting? *
If you work out, what do you currently do and how often?
If you're just starting, what type of exercise do you enjoy?
Do you have any stressors in your personal life? if yes explain. (this information will be kept private)
Do you feel energized throughout the day and prior to activities? If no, explain.
What do you struggle with when it comes to nutrition, healthy eating and/or exercise? (i.e. time, sugar addiction, knowledge of what to eat/do in an exercise program) *
Why do you want to make a change in your health and wellness? *
Do you have any injuries or other medical conditions that I should know about before our session? (i.e. high blood pressure, medications, surgeries, joint replacements, pregnancy etc.) Please list all medications
Please type your name after reading: It is recommended that you get medical clearance from a physician before beginning any new exercise routine.I hereby affirm that I am in good health and do not suffer from any disability which would prevent or limit my participation in this exercise program. I assume all risks related to Elizabeth Filippone’s (The Mindfully Fit Ninja, LLC) group fitness classes or Personal Training. I agree to hold Elizabeth Filippone and The Mindfully Fit Ninja, LLC harmless from all loss, claim, injury, damage, or liability sustained or incurred. I fully understand that I may injure myself as a result of my participation in class or Personal Training and I hereby release Elizabeth Filippone and The Mindfully Fit Ninja, LLC from any liability now or in the future. I hereby affirm that I have read and fully understand the above. ALL SALES ARE FINAL. THERE WILL NO MAKE UP CLASSES FOR CLASSES MISSED. *
A copy of your responses will be emailed to the address you provided.
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