Participant Application - Downsize
Lose up to 15 inches or more!
Name (First Last) *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Mailing Address *
Your answer
Birthday *
Your answer
Age (participants must be 18 years or older) *
Your answer
Are you a current tenant of Chase Tower? *
Tell us your story and why you would be a great fit for this program. *
Your answer
Tell us about your current exercise habits.
Your answer
Tell us about your current nutrition habits.
Your answer
What are your top 3 goals? *
Your answer
Have you tried other programs before to reach your goals and have they worked? *
Your answer
Are there any medical reasons that you should not participate in a program like this? *
Your answer
Do you currently take any medications that would interfere with exercise? *
Required
Do you follow any type of specialty diet? (ie. vegan, vegetarian, dairy free, allergen free, etc.) *
Your answer
What forms of protein do you normally consume?
Your answer
Do you have any known food allergies? *
Your answer
Do you have any known food sensitivities? (ie. things that cause gas, bloating, runny nose, etc.) *
Your answer
What liquids do you consume, how often and how much? (ie. water, daily, 60 oz) *
Your answer
Will your exercise availability be the same each week or will you need flexibility in session times? *
Required
How committed are you to finishing the 6 week program? *
Your answer
How did you hear about the DownSize program? *
Your answer
My friend is also signing up (friend's name for discount purposes)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Custom Fitness. Report Abuse - Terms of Service - Additional Terms