FORM: New Client Intake | Blaak Out Training

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BLAAK OUT TRAINING

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First name*

Last Name*

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Birthday*

Month

Day

Year

Referred by.*

I am filling out this form for-*

Myself

Someone else

If "Someone Else", please provide additional details.

How did you hear about Blaak Out Training?*

What is your height?*

What is your weight?*

What are your goals/reasons for considering personal training?*

Do you have past injuries, current pain or any limitations?*

What is your exercise and/ or sports history?*

Which services are you interested in?*

Private/ 1-on-1

Partner/Couples (2 people)

"Group Blaak" (3-5 people)

Bootcamp (5-10 people)

Sports Performance/Youth

Virtual

Other

Workout location*

In-Home Gym

Garage

Driveway

Local park

Other

What equipment do you have available? (Please be detailed)*

Preferred days available to train. (Please be detailed)*

Preferred times to train. (Please be detailed)*

Do you have a preferred trainer?

Yes

No- best fit please!

If "Yes", Please specify which trainer.

Additional information. (Life, family, situational ETC)

844-train15

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