Boot Camp Fitness Training Central Park NYC New York

Fill out this form to register for Manhattan Boot Camp. This questionnaire will help us understand your needs and goals.

REQUIRED INFORMATION
Full Name:
Email Address:
Phone Number:
OPTIONAL INFORMATION
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:
HEALTH AND FITNESS GOALS
What are your health and fitness goals? (be very specific)
Are you trying to diet and lose weight? yes no If yes, how much do you want to lose? lbs.
What areas of fitness interest you? Strength training Body Toning and Shaping Weight Loss Flexibility/Stretching Yoga Pilates Body Building Pre/Post Natal Postural Correction Nutrition Other:

BOOT CAMP SCHEDULE & LOCATION
Select the location and days you would you like to take boot camp? Monday and Wednesday at 6:30am on the Upper East Side Tuesday and Thursday at 7:30pm on the Upper West Side
EXERCISE HISTORY
Do you currently exercise on a regular basis? yes no
If yes, describe the frequency, intensity, time and type of exercise routine:
MEDICAL HISTORY
List any injury or medical condition that may limit your ability to follow a fitness program:
MISCELLANEOUS
List any additional information or questions that you may have:
Thank you for filling out this questionnaire. We will contact you within 48 hours after we receive your information.