Coaching Inquiry Form What type of coaching are you interested in? * Online In-Person Full Training Package (Includes both Online & In-Person) Programming Only Name * First Name Last Name Phone (###) ### #### Email * Age Height Weight City that you currently live in Desired Training Location * PWRBLD Warrington PWRBLD King of Prussia Preferred Trainer * Paige Brendan Aaron Dwardly David Sidney Sean Carolyn Nicole Dylan Chris Any I am a First Responder, Military, or Full Time Student Yes No How many times a week do you currently train? * 1x 2x 3x 4x 5x or more How many years have you been training for? * Less than a year 1-2 Years 3-5 Years 6-10 Years More than 10 years How many hours of sleep do you get on average per night? * Availability to meet with coach * Do you have intentions of competing in a sport or event this year? * Yes No Maybe If Yes, what is the sport or event and what is the date? What are your current 1RM (1 rep maxes) for Squat, Bench, Deadlift? * What is your current athletic background if any? * Do you have any previous injuries that could affect training? * If Yes, please indicate the injury and severity below. What are your specific training goals? * Have you tried another workout program before? If yes, please list, otherwise put N/A in the box * Have you had trouble adhering to a program in the past / maintaining positive results? If so, why do you feel that is? * Are you looking for faster results or sustainable results? * Faster Results Sustainable Results How did you hear about PWRBLD Gym / Coaching? * Instagram Facebook Internet Search Advertisement Friend YouTube Other If other, please specify. Were you referred by a current client or member? * If Yes, who ***LIABILITY RELEASE STATEMENT*** * I ACKNOWLEDGE THAT I AM CURRENTLY HEALTHY ENOUGH TO PARTICIPATE IN PHYSICAL ACTIVITY AND UNDERSTAND THAT THE COACH, COLLIN WHITNEY, OR WHITNEY STRENGTH & PERFORMANCE LLC WILL NOT BE LIABLE FOR ANY INJURY THAT MAY OCCUR DURING A TRAINING PROGRAM, PERSONAL TRAINING SESSION, OR UPCOMING MEET(S)/EVENT(S) DURING OR AFTER COMPLETION OF A SESSION OR PROGRAM. I agree to comply with the Liability Release Statement above. Signature * Date * MM DD YYYY Thank you!
