Coaching Registration Form

ONLINE COACHING

- application form -

LET'S GET MOVING. LET'S GET HEALTHY.

This is an application form for a free 30 minute health, fitness & nutrition consultation call to review your goals so that I can help you achieve your goals.

Whether your goal is to shred the last 5-10+ lbs of stubborn fat, to get more lean & toned or to get stronger – together we can accomplish it all.

Please take a few minutes to fill out the questions below with as much detail as possible as this will help me design a personalized program to fit your needs, availability and schedule.

1. Name *

First

Last

2. Contact Number *

3. Email Address *

Confirm Email

4. Instagram Handle *

write N/A if you don't have Instagram

5. City & Country of Residence *

6. Date of Birth *

* you must be 19 years or older to apply

7. Please check off if you are interested in in-person training

Yes, I am interested

(only for those who live in the Lower Mainland, Vancouver area)

8. How often do you workout? *

9. What are your main fitness goals? Check all that apply. *

10. What is your #1 goal you would like to accomplish during the next 8/12 weeks with me? *

11. Have you worked with a personal trainer, coach or mentor before? If so, explain your experience. *

* if no, just type "NO" or "N/A"

12. How did you hear about my coaching program? *

13. If there are any other details you would like to add or inform me about, please include them below.