First XV Performance
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Team First XV Sign Up Form
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Name
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First
Last
(First, Last)
Date of Birth
Date
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Mailing Address
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Home
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Emergency Contact Info
Name
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First
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Relationship to You
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Address
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Same
Emergency Contact Phone Number
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Choose One
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Home
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Favorite subject in school
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Favorite Movie, Ever?
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Yes this is required, it's very important.
A movie that you 100% regretted wasting your time on?
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Are you training for a sport or sports?
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Yes
No
If Yes, which one(s)?
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If multiple sports, which one are you trying to focus on?
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Check All That Apply
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Medical exam in the past 5 years
Currently on a special diet
Major surgery that required hospitalization in the lasy year
Currently pregant or given birth in the last 8 weeks
Physician has told you, that you have one of the following: high cholesterol, triglycerides or uric acid
History of high blood pressure
Do you have any of the following; diabetes, cancer, rheumatoid arthritis, epilepsy/seizures or other major diseases
Smoker
Anyone in your immediate family had a heart attack or major heart issues
None Apply
If yes, please specify
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If yes, please specify
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Favorite place you've traveled to and why?
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How many days a week are you practicing for your sport(s)? (Put 0 if not training for sports)
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Are you on any medications? Specify if needed (N/A if not)
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Check all that apply (from the last 12 months)
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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
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Have you had any of the following (check all that apply)
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Congenital heart disease
Rheumatic Fever
Stroke
Angina
Heart attack/failure
Heart bypass, vascular surgeru or angioplasty
Heart enlargement
Heart murmur
Abnormal resting or exercise electrocardiogram
Pain or tightness of the chest, neck, shoulders or arms at rest
Rapid beating of your heart not associated with exercise
Palpitations or skipped beats at rest or during exercise
Badly swollen feet or ankles
None apply
Cats, dogs, both or neither
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Check the following that apply
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Suffer from a pulmonary disease (asthma, emphysema) that may be aggrevated by exercise
Experience extreme shortness of breath after mild exercise
Recieving physical therapy
Lower back pain
Spinal disc problem
Major join dislocation
Cartilage or tendon tear
Arthritis or Bursitis
Ligament strain
Overuse condition of knee, shoulder, hip, elbow or other joint
Fractured bone
None apply (hey lucky you)
Any other medical issues that were not covered or additional notes?
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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
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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
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How mant days a week do you see yourself doing some sort of training via programming (either at CORE or at home)?
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What's important to you? (This is about you, not me)
Sweating during a workout
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Very Important
Important
Neutral
Somewhat Important
Not at all Important
Being sore after a workout
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Very Important
Important
Neutral
Somewhat Important
Not at all Important
Being tired after a workout
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Very Important
Important
Neutral
Somewhat Important
Not at all Important
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.
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Yes, totaly cool
No, prefer not
Additional comments, requests, questions or feedback?
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Checking below you acknowledge that you answered the above truthfully and to the best of your ability.
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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
Download File
Home
Get Started
Strength Camp
Testimonials
Contact
Ways to Start Training
FAQ
About First XV
Get Your Badge On (Store)
Blog
SimpleMovestoStronger
SignUpNextSteps