Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email Address
*
Phone
*
(###)
###
####
DOB
*
MM
DD
YYYY
Emergency Contact
*
Emergency Contact Phone
*
Assess your health needs by checking the box if 'Yes'
History - Have you ever had?
Symptoms - Do you experience or have you experienced?:
Are you?:
Do you have?:
Do you have any injury concerns or ongoing illnesses that might affect your 8 WEEK CHALLENGE experience? If yes, please tell me about them.
Do you take prescription medications, pills, tablets or supplements? If yes, please tell me about them.
What is your goal for The 8 Week Challenge? (Make it a measurable goal e.g. Lose 5kg, Do 10 Push Ups)
*
What else would you like to achieve in your 8 weeks? (Everyone has more than one goal, what else?)
*
How committed are you to achieving these goals?
*
1 - Not committed at all
2
3
4 - If it happens it happens
5
6
7 - Commited, bu may be barriers
8
9
10 - I'll do what ever it takes
How do you rate your eating habits?
*
1 - I start with a bottle of coke
2
3
4 - Moderate, but I snack a fair bit
5
6
7 - Healthy, but I enjoy a treat
8
9
10 - I'm a health machine!
What do you need to change with your eating habits?
How many days a week do you currently exercise?
*
1
1-2
2-3
3-4
4-5
5-6
6+
How Hard Do You Like To Train?
*
1 - I don't want to break a nail
2
3
4 - I could go for a light sweat
5
6
7 - What's the next exercise?
8
9
10 - I'm a beast!
Do you have any questions?
Sizing Information
*
Head to the link below:
https://onthegosports.com.au/pages/sizing-chart
WOULD YOU LIKE A PERSONALISED NAME ON THE BACK? (Extra $10)
Personalise Name
What personalised name would you like on the back?
What Size Would You Like?
*
Please enter your choice of sex, size and shirt or singlet.
Example:
Mens Size Medium T-SHIRT
Mens Size Small SINGLET
Ladies Size 14 T-SHIRT
Ladies Size 10 SINGLET
Please Select One
*
