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PRE-Consultation Form

* Indicates required field

Name *

First

Last

Email *

Skype Username (if available) *

Phone Number *

Age *

State *

How many times a week you train on average? *

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? *

Less than 1 year 1 - 2 years 3 - 5 years 6 - 10 years More than 10 years

How did you hear about me? *

Instagram Facebook Internet Search Advertisement Friend YouTube Other

If Other, please specify. *

Were you referred by a current client? *

Yes No

If yes, who? *

***LIABILITY RELEASE STATEMENT***
I ACKNOWLEDGE THAT I AM CURRENTLY HEALTHY ENOUGH TO PARTICIPATE IN PHYSICAL ACTIVITY AND UNDERSTAND THAT COLLIN WHITNEY, OR WHITNEY STRENGTH & PERFORMANCE LLC, WILL NOT BE LIABLE FOR ANY INJURY THAT MAY OCCUR DURING A TRAINING PROGRAM, PERSONAL TRAINING SESSION, UPCOMING MEET(S)/EVENT(S) DURING OR AFTER COMPLETION OF A SESSION, PROGRAM, OR SKYPE CONSULTATION.

Please indicate that you understand and agree to the Liability Statement by e-signing below. *

I agree to comply with the Liability Release Statement above.

Signature *

Date *

Submit

Home
About
PWRBLD Membership
- PWRBLD Account
Training
Shop
- PWRBLD & WHITNEY SP APPAREL
- SLINGSHOT EQUIPMENT
Testimonials
Contact Me