Marathon Fitness

* Your name:

* Cell Phone:

* I am registering for the following::

Assessment Only (45 min, no workout) $35.00 plus 10% fee ($38.50)

Personal Session (45-min workout, basic meal plan) $60.00 plus 10% fee ($66.00)

Combo Session (90 min session) $80.00 plus 10% fee ($88.00)

* Email Address:

* Gender:

* Age:

* Date of Birth:

* Height (XX-XX); Weight (XXX):

* Goal Weight (XXX):

* Marital status:

Single

Married

Newlywed

Divorced

Separated

* Number of children:

1-2

3-4

5-6

7 or more

* Number of grandchildren:

1-2

3-4

5-6

7 or more

* Home address:

* City and Zip Code:

* Employer, Occupation, or School:

Students: select grade:

* Medical Insurance Provider & Member ID or Entry N/A:

* Emergency Contact & Phone No.:

* Describe your lifestyle:

Sedentary/don't like group fitness

Sedentary/need to be motivated

Lightly but I start and stop frequently

Lightly or moderately active (1-2 times a week or only on weekends)

Active (3-4 times a week including weekends)

Very Active (every day but need an extra push)

* What time do you wake up?:

* What time do go to sleep?:

* Do you smoke ANYTHING?:

* Do you drink alcohol (socially or otherwise)?:

* Describe what type of other liquids you drink? (water, Gatorade, etc.):

* Describe your favorite type(s) of food:

* List any serious medical family history:

* Please list all pre-existing injuries, surgeries, and medical history:

* Are you aware of any disease or disorder that would complicate your session?:

* Are you under the care of a medical professional? If yes, please describe why.:

* Are taking any medication (name, type, prescribed or not, frequency)?:

PICK ONLY 3 TRAINING PRIORITIES (use space following this section for answers)

Proper workout area at home
Muscle tone/increase strength
Develop a routine
Injury rehab
Sports-specific training
Special needs (medical, physical)
Equipment purchases

* :

PICK ONLY 3 ASSESSMENT PRIORITIES (use space following this section for answers)

Develop good eating habits
Develop a daily routine
How to dine out
Portion control
Healthy supplements
Family/cultural issues
Relationship issues

* :

* Explain why you like or don't like the gym?:

* Form of Payment:

I will pay online

I will pay using Venmo app

I will pay in cash prior to my session

* I am fully aware and fully understand the information above & cancellation policy:

Yes

* Today's Date:

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IMPORTANT: Online Payment with credit cards is not active for this form

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Assessments and Training (non-athletes)