Member Registration Form Online Training Registration FormWelcome to IntoFitness! We are really looking forward to you working with you because we know how much this is going to change your life. Before we get started, this is an important part of getting to know you and to ensuring you are safe to train with us. Your participation in this program is at your own risk and sole responsibility. To ensure your safety, please speak with your health care provider before commencing exercise. Your responses are treated as confidential and will only be revealed to relevant third parties if required for your safety. About YouEmail* Name* First Last Date Of Birth* Date Format: DD slash MM slash YYYY Current Age*Mobile Number*Postal Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Occupation*Would you describe your job as sedentary or active?* Sedentary - sitting down for most of the day at a desk or in the car. Active - on my feet, on the go, physically active. Do you play any sport, or do any physical activity?* Yes No If yes, please describeTell me about your previous exercise history, including experience using workout equipment, working out at home, or working with a Personal Trainer.* Yes No How did you hear about us?* Google Facebook Instagram A Friend Other CommentWhat attracted you to our Online Membership?*On a scale of 1-5 with 1 being the highest, describe your level of commitment to this.*12345What goals do you want to achieve?*When do you want to achieve this by?*And what would this really mean for you?*Health & MedicalWe take your health and safety very seriously and the information you provide is critical to your care before commencing training with us. All information is treated with privacy and confidentiality. Please tick the conditions applicable to you now or within the last 12 months: Arthritis or any other joint pain or condition Asthma or any other respiratory condition Diabetes or any other metabolic condition Epilepsy, fainting or dizziness Any condition effecting the heart High blood pressure Low blood pressure Infectious or chronic disease Any injuries in the last 6 months Any surgeries in the last 12 months Pregnancy or child birth in last 12 months Pelvic Floor weakness or Prolapse Diastasis Recti / Addominal separation Thyroid Condition Depression, Anxiety or Mood Disorder Eating Disorder Please provide the details of any conditions ticked above, including medical intervention or care you are currently receiving or have received, and specifically any limitations around exercise.*Has a medical doctor, or any other medical professional, advised you not to exercise, or to take special precautions around exercise in the last 12 months?*YesNoDo you take any medications that make it inadvisable or cautionary to exercise? Please describe*Your Online Training ScheduleIt's important to think about your schedule and how you will build this in around your current lifestyle. Let's begin. How many workouts per week will you commit to?*When will you schedule these workouts in?*Are there any factors that may hold you back from achieving your goals?*THE WAIVERAll exercise and physical activity performed is at the individuals own risk. Given the nature of this online training product, IntoFitness is unable to ensure a safe environment including but not limited to hazardous surroundings and incorrect technique. IntoFitness is not liable for any injury (including death), loss or damages which may arise while using any product including but not limited to personalised workout programs and ebooks sold IntoFitness. By purchasing a personalised workout program, ebook or any digital content you warrant that you: • Understand that exercise, training and any form of physical activity can be potentially dangerous. • Declare that you are fit to participate in exercise or any form of physical activity. • Suffer from no conditions or injuries that may prevent you from participating in any exercise or physical activity, and that if you are unsure, you will seek medical opinion and advice. • Have been given consent by a medical professional to begin an exercise program, or engage in any physical activity if you do not satisfy the above points. • Accept all terms and conditions outlined.SignatureThe parties agree that the electronic signature of a party to this Agreement shall be as valid as an original signature of such party and shall be effective to bind such party to this Agreement.Legal Name* First Last Today's Date* Date Format: DD slash MM slash YYYY Signature This iframe contains the logic required to handle Ajax powered Gravity Forms. Membership Options Monthly Direct Debit $49/Month Join Now Yearly Upfront Payment $499/Year Join Now Privacy Policy Terms & Conditions Contact Us COPYRIGHT 2020 INTOFITNESS FollowFollowFollow Designed by Karine Marie
