Athlete Intake Form

Contact Information

Name

First Name

Last Name

Date of Birth

YYYY

Cell or best contact number

Email Address

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

First Name

Last Name

Emergency Contact Phone

Health

Height

Weight

Are there any other physical, medical or emotional problems that may affect your training?

Yes

Are you aware, through your own experience or a doctor’s advice, of any other physical reasons against your exercising without medical supervision?

Yes

Are there any other physical, medical or emotional problems that may affect your training?

Do you have any acute or chronic injuries? or even little nagging issues?