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(6 MONTH
)
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Name
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First
Last
Email
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Phone Number
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I am a Military, LE, or First Responder
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Yes
No
Age
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State
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Alabama
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Height
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Weight
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How many times a week you train on average?
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Once per week
2 to 3 times per week
4 to 5 times per week
6 to 7 times per week
How many years have you been lifting?
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Less than 1 year
1 - 2 years
3 - 5 years
6 - 10 years
More than 10 years
How many hours do you sleep each night on average?
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What style of squat do you prefer?
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Low Bar
High Bar
Not Sure
What style of deadlift do you prefer?
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Conventional
Sumo
Not Sure
Do you have intentions of competing in a powerlifting meet within the next year?
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Yes
No
Maybe
What are your current Squat, Bench, and Deadlift PRs?
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What type of specialty bar(s)/equipment do you have access to?
*
***Please Note: You will be asked to send a video of your squat, bench,
and deadlift to check your technique. Please acquire a video of each lift
on your next available training day if you do not have a current video.***
What is your athletic background? Sports?
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Do you have any previous injuries that could affect training?
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Yes
No
If Yes, please indicate injury and severity below.
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What are your specific training goals?
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Are you interested in game day coaching for meets?
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Yes
No
Maybe
How did you hear about me?
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Instagram
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Friend
YouTube
Other
If Other, please specify.
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Were you referred by a current client?
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Yes
No
If yes, who?
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***LIABILITY RELEASE STATEMENT***
I ACKNOWLEDGE THAT I AM CURRENTLY HEALTHY ENOUGH TO
PARTICIPATE IN PHYSICAL ACTIVITY AND UNDERSTAND THAT
THE COACH, COLLIN WHITNEY, OR WHITNEY STRENGTH &
PERFORMANCE LLC WILL NOT BE LIABLE FOR ANY INJURY THAT
MAY OCCUR DURING A TRAINING PROGRAM, PERSONAL
TRAINING SESSION, OR UPCOMING MEET(S)/EVENT(S) DURING OR
AFTER COMPLETION OF A SESSION OR PROGRAM.
Please indicate that you understand and agree to the Liability Statement by e-signing below.
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I agree to comply with the Liability Release Statement above.
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Date
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Home
About
PWRBLD Online
PWRBLD Account
Training
Level Up Program
Online Training Options
Personal Training
1:1 Consultation
Shop
PWRBLD Merch
Testimonials
Contact Me
Personal Training