Let's Get to Know You More:

Step 1 of 2: Fill out our Pre-Qualification Questionnaire

Est. Time to Complete: 5 Minutes

Full Name

Email *

Phone *

Date of birth *

How'd you hear about us? *

Do you currently have or have had any injuries/surgeries? *

Yes

If Yes what are they? *

Are there any health-related contraindications (CVD) or prescribed medications that would affect your physical fitness? *

Yes

If Yes how would you describe it? *

What struggles/challenges are you currently facing in regards to your Health & Fitness? (time, accountability, nutrition, etc) *

Are you currently lifting weights or doing body weight exercise? *

Yes

If so, what type, how many days, and how long? *

Are you currently doing any cardiovascular exercise? *

Yes

If so, what type of cardio do you do? (Running, Walking, Swimming, HIIT, Cycling, etc.) And how many days a week do you complete your cardio sessions? *

Have you worked with a personal trainer before? *

Yes

Where do you see yourself 3–6 months from now, what would you like to accomplish, and how would you like to feel? *

If you feel the strategy we provide you whether it be working privately with a coach would you be willing to invest in yourself? *

What’s driving you to make a change right now? *

If you joined, which 3 days work best for your training sessions? *

If you joined what time frames works best on those days? *

Anything

If you joined, how may days would you like to train? Typically our most successful clients work with a coach 2-3 times a week. *

1 time a week

2 times a week

3 times a week

4 times a week

Waiver

1. Agree that prior to participating, they will inspect the area of activities/facilities and equipment to be used, and if they believe anything is unsafe, they will immediately advise Uplifted Athletics of such condition(s) and refuse to participate. *

Yes I agree

2. Acknowledge and fully understand that even with utmost supervision and proper training methods, each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economical losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to Uplifted Athletics or not reasonably foreseeable at this time. *

Yes I agree

3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death. *

Yes I agree

4. Release, waive, discharge and covenant not to see UPLIFTED ATHLETICS, its affiliated clubs, regional sports organizations, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessees of premises used to conduct the event, all of which are hereinafter referred to as “releases”, from any all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the release or otherwise. *

Yes I agree

5. Grants Uplifted Athletics, its representatives, agents, and assigns (collectively, "the Company"), the irrevocable right and permission to photograph, film, videotape, record, and/or portray my image, likeness, voice, statements, and/or biographical information (collectively, "Media Materials"), and to use, reproduce, publish, distribute, broadcast, and/or display such Media Materials, in whole or in part, in any and all media now known or hereafter developed, including but not limited to print, digital, electronic, online, social media, and broadcast media, for any lawful purpose whatsoever, including but not limited to promotional, marketing, advertising, educational, and/or informational purposes. I hereby waive any right to inspect or approve the finished product, including written copy, that may be created in connection with such Media Materials. I understand and agree that I will not receive any compensation for the use of my image, likeness, voice, statements, and/or biographical information as described herein. I hereby release, discharge, and hold harmless the Company, its representatives, agents, employees, licensees, and assigns, from any and all claims, demands, actions, causes of action, suits, costs, expenses, liabilities, and/or damages whatsoever that I may have now or in the future arising out of or in connection with the use of the Media Materials, including but not limited to any claims for invasion of privacy, defamation, or infringement of intellectual property rights. *

Yes I agree

PAR-Q+

1. Has your doctor ever said you have a heart condition and that you should only engage in physical activity recommended by a doctor? *

Yes

2. Do you feel pain in your chest when you engage in any physical activity? *

Yes

3. In the past month, have you had chest pain when you were not engaging in physical activity? *

Yes

4. Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes

5. Do you have any issues with your bones or joints (for example, back, knee, or hip) that could be made worse by a change in your physical activity? *

Yes

6. Is your doctor currently prescribing medication for your blood pressure or heart condition? *

Yes

7. Do you know of any other reasons why you should not engage in physical activity? *

Yes

HERE’S THE NEXT STEP:

Thanks for filling out the form! Your FREE SESSION is ready to claim. Click NEXT and pick a few days and times that fit your schedule—we'll take it from there and lock in your spot. No

commitment, just come see if we're the right fit for you.

Free Session

When works best for you?

Pick a few options and we'll match you to a time, then confirm by text. Try it out before you commit — no obligation.

What time of day? *

Morning (5:00 AM - 10:00 AM)

Afternoon ( 11:00 AM - 4:00 PM)

Evening (4:00 PM - 8:00 PM)

HERE’S THE NEXT STEP:

Click submit and our team will reach out to confirm your free session! If you have any questions please reach out to us at [email protected]