Outdoor Group Fitness Sign Up Form Page 2
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1
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3LIFESTYLE QUESTIONNAIRE
How would you rate your current fitness level? (please circle)
(10 being very fit)
How would you rate your current diet? (please circle)
(10 having a very healthy diet)
Current Occupation
Rate your activity
Largely in-active
Lightly active
Heavily active
levels at work
(eg. Desk job)
(eg. Teacher,
(Bricklayer Labourer)
(Please Circle)
household)
EXERCISE HISTORY
How often have you exercised in the
Duration of exercise?
Level of daily activity?
last 6 months?
Never
Up to 30 min
Low
1-3 times per week
30-60 min
Medium
4-5 times per week
60-90 min
High
5+ times per week
90+ min
What exercise(s) do you enjoy? Any particular likes/dislikes?
HEALTH AND FITNESS GOALS
What are your reasons for considering our Team One Fitness group classes?
What are your health and fitness goals? (Please Circle)
Improve General Health
Gain Strength
Reduce Stress
Muscle Toning
Build Lean Muscle
Self-Esteem
Weight Maintenance
Rehabilitate
Have fun/meet people
Gain Weight
Flexibility
Increase Energy
Upcoming Sport or Social Event Training (detail/date)
Lose Weight (please circle)
0 – 5 kg
5 – 10 kg
10 - 20 kg
20+ kg
Is there anything else you think might be relevant for us to know?
PHOTO CONSENT
I (Full Name) ____________________________
give permission to Yves Minten trading as Team One Fitness ("Team One Fitness") to use my:
Name
Yes □
No □
Testimonial
Yes □
No □
Image/Photograph
Yes □
No □
in publications and advertisements produced by or for Team One Fitness
I understand that these publications will also be placed on websites managed by Team One Fitness for public relations and
advertising purposes.
Signature: ____________________________________________Date: ____________________________
Team One Fitness
ABN 56 924 318 903
.au
M: 0424 245 578
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Parent category: Life