Registration Form

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fILL UP THE FORM

2

STEP 2 OUT OF 3

6 WEEKS PACKAGE

Name *

First

Last

Gender *

Date of birth *

Email *

Weight *

KG

Height *

CM

Which program do you want

Gym
Home

Your Fitness Goals

Weight Loss
Fat Loss
Bulking
Endurance
Flexibilty
Muscular Strength
Appearance
Fitness
General Conditioning
Toning & Shaping
Posture

Do you exercise regularly?

I have never exercised regularly
I used to exercise regulary
I exercise every now and then
I currently exercise regularly

Do you have any diagnosed health problems

Asthma
Arthritis
Heart disease
Lung disease
High blood pressure
Low blood pressure
Shortness of breath
Blood cholesterol
Thyroid condition
Diabetic
Kidney disease
Gastric problems

Please list any current or past injuries that could prevent certain activities:

Back Problems
Muscle disorder
Joint dislocation
Tendon/ Ligament Tear
Recent Surgery (last 12 months)

Are you a smoker

Yes
No

Are you pregnant

Yes
No

Rate your activity level

Selected Value: 0

MEAL PLAN

CHOOSE YOUR PROTEIN (At least 4)

Beef
Lean Ground Beef
Fish
Chicken
Salmon
Tuna
Eggs
Protein Shake
Shrimp
Tofu
Greek Yogurt

CHOOSE YOUR CARBS (At least 4)

Rice
Whole-Wheat Pasta
Whole-Grain Toast
Sweet Potatoes
Oats
Quinoa
Potato
Sweet Corn

CHOOSE YOUR FATS (At least 4)

Avocado
Olives
Chia Seeds
Nuts
Almonds
Peanut Butter
Olive Oil
Dark Chocolate
Egg Yolks
Kitkat

CHOOSE YOUR VEGETABLES (At least 4)

Broccoli
Spinach
Carrot
Tomatoes
Cucumbers
Mushrooms
Onions
Pepper
Asparagus
Brussel Sprouts

CHOOSE YOUR FRUITS (At least 3)

Kiwi
Banana
Orange
Apple
Pineapple
Berries
Watermelon

Upload Front, Side, Back picture of your body *

Click or drag files to this area to upload. You can upload up to 3 files.

Comment

fILL UP THE FORM

2

STEP 2 OUT OF 3

MEAL PLAN

SUGGESTED FRONT, SIDE, BACK PICTURES