21 Day Fix Challenge Group Application

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I'm Kim Danger, a 5-Star Diamond Elite Team Beachbody Coach. I am looking for a select group of participants I can mentor in a 21 Day challenge group. Please only apply if you are motivated to make a change and are committed to sticking to the program for the full 21 days.

Email *

Option 1

Clear selection

Your Full Name *

Your Email *

Your age

Do you have the 21 Day Fix program already? *

Yes

What is your long-term fitness goal? *

What is your 21-day goal? *

If weight loss is your goal, how much would you like to lose long-term?

Maintain or lose around 5 pounds

Lose 5-15 pounds

Lose 15-25 pounds

Lose 25-50 pounds

Lose 50-75 pounds

Lose more than 75 pounds

Other:

Clear selection

What are the main obstacles holding you back from achieving your goals? *

What is motivating you to make a change now? Why would you like to be included in this group? *

Are you working with a Team Beachbody coach? *

Yes - Kim or Scott Danger is my coach

No - I don't have a coach

Unsure - I'm not sure if I have a coach

I have another coach assigned to me, but I'm not actively working with him/her

I am actively working with another Team Beachbody coach in a challenge group

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