Team First XV Sign Up Form

* Indicates required field

Name *

First

Last

Date of Birth

Date *

Month *

Year *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Email *

Preferred Phone Number *

Choose One *

Home Cell (Mobile) Other

Emergency Contact Info

Name *

First

Last

Relationship to You *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Check If Same As Above Address *

Same

Emergency Contact Phone Number *

Choose One *

Home Cell (Mobile)

Favorite subject in school *

Favorite Movie, Ever? *

A movie that you 100% regretted wasting your time on? *

Are you training for a sport or sports? *

Yes No

If Yes, which one(s)? *

If multiple sports, which one are you trying to focus on? *

Favorite place you've traveled to and why? *

How many days a week are you practicing for your sport(s)? (Put 0 if not training for sports) *

Are you on any medications? Specify if needed (N/A if not) *

Check all that apply (from the last 12 months) *

Headaches that stopped you from what you are doing Headache combined with racing heart and sweating Faitness or lightheadedness when you stood up too fast Heart beating unusually fast or skipping Blacking out/losing consciousness None Apple

Favorite word *

Cats, dogs, both or neither *

Any other medical issues that were not covered or additional notes? *

Heaven and Hell

One year from now, what is the best case scenario for you and your training? Describe to me as best as you can, what that looks like *

On the other side of the coin, one year from now, what is the worst case scenario for you and your training? Describe to me as best as you can, what that looks like *

How mant days a week do you see yourself doing some sort of training via programming (either at CORE or at home)? *

What's important to you? (This is about you, not me)

Sweating during a workout *

Being sore after a workout *

Being tired after a workout *

Final Question: Sometimes in the gym I'll post videos and pictures to social media. Are you ok with this? If not check no and I'll be sure you aren't posted. *

Yes, totaly cool No, prefer not

Additional comments, requests, questions or feedback? *

Checking below you acknowledge that you answered the above truthfully and to the best of your ability. *

Yes

Submit

Very last thing, if you could please download this waiver, sign it and bring it in or scan it and send it back, I'd love you forever.

fxvpwaiver_18_.pdf
File Size:	117 kb
File Type:	pdf

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