Training Application Name * First Name Last Name Email * Phone (###) ### #### Major Goals * If you experience chronic pain (pain lasting longer than 3 months), please describe it below If you are recovering from a recent injury, please describe it below If you are recovering from a recent injury, have you been cleared by a doctor to begin an exercise program? Yes No Physical Activity Readiness Questionnaire (PAR-Q) * Check all that apply 1. A doctor has told you that you have a heart condition and that you should only perform physical activity recommended by a doctor. 2. You feel pain in your chest when you perform physical activity. 3. In the past month, you have experienced chest pain when you were NOT performing any physical activity. 4. You lose your balance because of dizziness or you lose consciousness. 5. You have a bone or joint problem that could be made worse by a change in your physical activity. 6. Your doctor is currently prescribing medication for your blood pressure or for a heart condition. 7. There is another reason why you should NOT engage in physical activity. 8. None of the above apply If you checked any of the statements 1-7 above, consult with your physician before engaging in physical activity. If any of the above statements apply to you and you decide to participate in a training program without consulting your physician first, please be advised that you are fully responsible for any injury as a result of your participation. We strongly advise you to consult with your physician before participation. Date * MM DD YYYY Thank you for your application!You will be contacted shortly through the email provided with the next steps to take to begin training!