Join a Base Fit GymThinking about starting your fitness journey with us? Simply fill in this form, and our coaching team will get back to you with pricing and training options.(No obligation to sign up)Download PDF below to see how Base Fit works. Download PDF Full Name Birth Date Cell Num Email Weight Height Area Of Residence Select a gym Bishopstowe Centurion Fourways Stellenbosch West Rand Online Session Preference Bravo - 2 Weekly sessions Charlie - 3 Weekly sessions Delta - 4 Weekly sessions Heart/Cholesterol/Blood pressure Heart problems Cholesterol problems Blood pressure problems Surgery / serious illness in the last 2 years? Yes No Asthma / diabetes / epilepsy / orthopaedic problems? Asthma Diabetes Epilepsy Orthopaedic Are you on any medication currently? Yes No** If you have answered yes any of the above please consulted with your doctor before training at Base Fit. Meals: How many times a day do you eat meals and when? Give examples of what you eat and how much Snacks: How many times a day do you snack and when? Give examples of what you snack on and how much Liquids: How many times a day do you drink liquids and when? Give examples. Include amount of sugar/sweetener in tea/coffee etc Do you smoke? # per day? How often to do you drink alcohol, and how much? How many hours quality sleep do you get?ACTIVITY * How active have you been this past year. What you have been doing and how often. Sport/Activity Times/Week Duration/Intensity What injuries if any do we need to know about that may effect you preformance? Short Term Goals Mid Term Goals Long Term Goals What blocks have prevented you from previously achieving your goals? How committed are you to achieving your goals while working with us? Where did you hear about Base Fit? Social Media Referral Competitions Word of Mouth Other What other physical activities will you be doing other than Base Fit? Todays Date Full NameToday’s Date:Full Name:I acknowledge that whilst the exercises suggested by Base Fit have been designed and constructed to be beneficial, the use thereof constitutes a potential risk of physical injury and/or harm to the participant. I hereby indemnify and hold harmless Base Fit and its directors, officers, employees, agents, representatives and/or nominees from and against any liability, loss, damage, claims and/or costs of whatsoever nature and howsoever arising from or connected with or incidental to my use of the exercises and/or participation in any Base Fit activity. I acknowledge that I have read and fully understand the above declarations. EVENTS/RACES/SPORTING ACTIVITIES ENTERED RECENTLY Date Notes Result EVENTS/RACES/SPORTING ACTIVITIES ENTERED RECENTLY Date Notes Result EVENTS/RACES/SPORTING ACTIVITIES ENTERED RECENTLY Date Notes Result EVENTS/RACES/SPORTING ACTIVITIES ENTERED RECENTLY Date Notes ResultSPORTING EVENTS/RACES/ACTIVITES PLANNED IN THE NEXT 12 MONTHS * Indicate which races are the most important Event Importance Event Importance Event Importance Event Importance What are your riding/sport strengths? What are your sporting weaknesses? What (enduro) bike do you ride? Anything you are unsure of? Submit
Thinking about starting your fitness journey with us? Simply fill in this form, and our coaching team will get back to you with pricing and training options.(No obligation to sign up)