Welcome to Your Performance Journey!

Name *

First Name

Last Name

Date of Birth *

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DD

YYYY

Phone *

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1. Do you have any known medical conditions? *

Yes

No

2. Have you ever been diagnosed with any of the following? *

Chest Pain

Dizziness or Fainting

Shortness of Breath

Unusual Fatigue

I confirm that I do not experience any of these symptoms

3. Have you had any recent surgeries, injuries, or physical therapy? *

Yes

No

5. Emergency Contact Phone Number *

(###)

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*

By checking this box, I confirm that I have read, understood, and agreed to the Terms of Service & GDPR Policy

Date of Agreement *

MM

DD

YYYY