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Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Age*

Date of Birth*

Emergency Contact Name*

First Last

Emergency Contact Phone Number*

We would love to know how you found us:*

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Please check yes or no below. I am interested in scheduling a time with a Personal Trainer to acquaint me with basic exercises and equipment.*

yes
no

We want to make sure you are successful in accomplishing your health & fitness goals. Our trainers are more than happy to help acquaint you with basic exercises and offer support and guidance. Please check yes or no below.

I am interested in the Jump Start Program.*

yes
no

The Jump Start Program is 3 sessions to teach you how to correctly and effectively complete your workouts yielding the results you want. It also includes a written exercise program specifically tailored to your fitness goals.

Do you have injuries or health conditions that may limit exercise?*

I have NO injuries or health conditions that may limit exercise.
YES I have injuries or health conditions that may limit exercise and they are listed below.

My injuries or current physical limitations are:

We can schedule a time with a Personal Trainer to help you rehabilitate your injuries through a personalized corrective strengthening and stretching protocol.*

Yes, I am interested in scheduling a time with a Personal Trainer to help rehabilitate my injuries.
No, I am not currently interested in scheduling a time with a Personal Trainer to help rehabilitate my injures.

Cancellation Policy: We require a 7 day notice VIA EMAIL ONLY for any membership cancellation to ensure that you will not be charged. Please read and check below.*

Yes, I have read and understand the cancellation policy.

Cell Phone Policy: As a courtesy to others, please take your calls outside the gym.*

Yes, I understand the take my calls outside the gym policy.

**NO SIGNATURE REQUIRED YET. SIGN ONLY WITH STAFF.

I will sign this document upon my first visit to South Park Fitness. This document will be printed for me on my arrival.

My printed name as I would like to be called.*

First Last

For example if your legal name is Elizabeth but everyone calls you Lizzie. Please state here. Thank You!

What is the color of the ocean?*

This is a Bot Blocking question. You must answer the question correctly to submit this form.

Name

This field is for validation purposes and should be left unchanged.

South Park Fitness Questionnaire