Kick-start Get Started Application

1
Full Name* This field is required.
First Name
Last Name
2
Birth Date* This field is required.
Month
Day
Year
3
E-mail* This field is required.
4
Phone Number* This field is required.
Area Code
Phone Number
5
Best Time to Call* This field is required.
9am - 11am
11am - 1pm
1pm - 3pm
3pm - 5pm
6
Referred By
Family/Friend
Client
School Event
Team Event
Mailing
Flyer / Postcard
Facebook
Google
7
What are your fitness goals?* This field is required.
Weight Loss
Weight / Muscle Gain
Improved Healthy
Prevent Injury
Other
8
What concern(s) do you have with this program?* This field is required.
NONE
Injury - Not sure I can handle it
Out of Shape - Not sure I'm fit enough
Lone Wolf - I've never been a fan of group classes
Location - Don't know if I can get there
Cost - Money is pretty Funny right now
Other
9
What are you hoping to achieve?* This field is required.
Look better in my skin
Improved Health
Be an example for my kids
Get motivated
Fit into my new dress
Other
10
Are you GOOD working out around others?* This field is required.
No problem
Don't know
Not really, but I'll give it a try
11
Any injuries or limitation our coaches need to know about?* This field is required.
Please Select
Please Select
Yes
No
If Yes, please describe above
12
Par-Q* This field is required.Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO
Yes
No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Row 0, Column 0
Row 0, Column 1
Do you feel fain in your chest when you do physical activity?
Row 1, Column 0
Row 1, Column 1
In the past month, have you had chest pain when you were not doing physical activity?
Row 2, Column 0
Row 2, Column 1
Do you lose balance because of dizziness or do you ever lose consciousness?
Row 3, Column 0
Row 3, Column 1
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Row 4, Column 0
Row 4, Column 1
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Row 5, Column 0
Row 5, Column 1
Do you know of any other reason why you should not do physical activity?
Row 6, Column 0
Row 6, Column 1
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel fain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
Yes
Row 4, Column 0
No
Row 4, Column 1
Yes
Row 5, Column 0
No
Row 5, Column 1
Yes
Row 6, Column 0
No
Row 6, Column 1
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13
Anything else you'd like us to know about your fitness journey?
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Ok
Ok
14
Waiver & Release of Liability* This field is required.
Waiver & Release of Liability - I, have volunteered to participate in a physical training under the direction of Go Good Guru which will include, but may not be limited to, weight and/or resistance training.In consideration of the Go Good Guru agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold harmless Go Good Guru, and their respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting there from.THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT AND (3) OUR NEGLIGENT INSTRUCTION OR SUPERVISION
15
Assumption of Risk* This field is required.
Assumption of Risk - There could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure; fainting; disorders in heartbeat; heart attack; and, in rare instances, death.I understand that as a result of my participation, I could suffer an injury or physical disorder that could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life.I recognize that an examination by my physician must be obtained prior to involvement in this exercise program. I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate.
16
I have read, understood and completed this questionnaire to my full satisfaction* This field is required.
I acknowledge and agree
17
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