APPLICATION FORM -
APPLICATION FORM -
APPLICATION FORM -
APPLY FOR FITNESS COACHING
WITH GARDENIA DIAZ
Gender
Male
Female
What's the activity level of your job?
None (seated only)
Moderate (light activity such as walking
High (heavy labor, very active)
What does your workout schedule look like?
I consistently work out during the daytime
I consistently work out during the night time
I am inconsistent in my workout routine
I have not worked out in over 2 years
How much weight training experience do you consider yourself having?
Brand new to weight training (zero experience).
Beginner (some experience in the past.)
Intermediate (familiar and experienced with exercises like barbell squats, barbell deadlifts deadlifts, Leg press, lat pull down).
Advanced (training HARD 4-5 days a week currently, know how to do everything in the gym, knows: drop sets, tempo training, super sets, complex movements and techniques).
Are you experiencing any stresses or motivational problems?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
Timeline for achieving your goal:
8 weeks
16 weeks
24 weeks
32 weeks
40 weeks
1 year
Please rate your motivational level to do what it takes for reach your goal:
1
2
3
4
5
6
7
8
9
10
Have you trained with an online trainer or personal trainer before?
Yes
No
At what times during the day do you prefer to train?
Morning
Mid-day
Afternoon
Evening
I would like to receive future communications
I agree to the GDPR & CCPA Terms & Conditions
I confirm that I am at least 16 years of age or older
I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services.
I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services.
I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be required to use cookies or similar tracking to provide those products or services..
I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format.
I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be unable to provide contracted products or services to me, and I can not hold you responsible for that.
Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the email address provided.
SUBMIT
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