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Please fill out this form after you've registered for the 12 Days of Fitness. Call 612.866.0832 to register.
12 Day Trial Form
First Name
*
Last Name
*
Email (we will keep your email completely private)
*
Phone
*
What is your fitness experience?
*
I'm currently exercising regularly
I used to exercise and want to get back to it.
I've rarely or never exercised.
Something else
What do you want to get from exercise?
Lose body fat
Improve strength
Improve flexibility
Increase muscle tone/definition
Change my body shape
Start exercising regularly
Change up my exercise program
Improve my health in general
Meet new people
Improve my exercise technique
Fun
What kind of class experience appeals to you?
Just to be able to make it through a 60 minute workout.
Encouragement from the instructor.
Friendly people in the class.
Kick butt workout..super challenging.
I don't want to sweat much.
I love to sweat in class.
I like smaller classes.
I like big, energetic classes.
I want personal attention from the instructor.
I would rather be left alone.
How did you find out about the 12 day trial?
Online search
Friend
mailing
other
Do you currently belong to a health club?
*
yes
no
If yes, do you use the club?
yes
no
The more we know about your physical condition, the better we can help you. Check all that apply.
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Knee pain with weight on one bent leg
Knee pain when kneeling on the floor.
Knee pain all the time.
Knee replacement
Hip replacement
Hip trouble
Low back pain
Neck trouble
Shoulder trouble
Wrist problems
Arthritic toes that don't bend well or hurt
Arthritic hands that make it difficult to hold weights
Osteoporosis
Osteopenia
Very stiff and inflexible
Trouble getting up and down off the floor
Herniated disc in the past
Pregnant
Given birth in the last year
Which class types interest you the most? Check all that apply.
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Behind Bars (sculpting)
STEP (cardio)
PUMP (weight training)
Nia (barefoot movement)
JAM (MTV dance)
Pilates (core strength)
Yoga
BodyShaping (strength)
Don't know
Have you done Pilates mat?
*
yes
no
Pilates reformer?
*
yes
no
Are you interested in a complimentary 45 minute Pilates 101 session with a trainer to try the reformer and learn about the best Pilates options for you?
*
yes
no
Any questions or comments?