Enrollment Form

Congratulations on choosing Capital Energy Training!

Before we get started, we want to gain a better understanding of your fitness needs.  Please fill out the form below to help us design your personalized fitness program.  Additionally, you will also need to sign this liability form before your first training session.

All information is confidential.

The Basics
Name *
Name
Date of Birth *
Date of Birth
Gender *
Contact Information
Phone Number *
Phone Number
Alternate Phone Number
Alternate Phone Number
Example: Office phone number
Home Address *
Home Address
Note: You must provide values for "Address 1", "City", "State", "Zip/Postal Code", and "Country".
Your Story
Health Questionnaire
When was your last medical checkup? *
When was your last medical checkup?
Do you smoke? *
Do you have any heart conditions? *
Have you ever experienced chest pains while exercising? *
Do you have high blood pressure? *
Do you ever lose balance because of dizziness or lose consciousness? *
Do you have any muscle, bone, or joint conditions? *
Do you suffer from back pain or any other pain? *
Have you had any surgery in the past two years? *
Do you know of any other reason why you limit or avoid physical activity? *
Do you have any of the following conditions?
Your Availability
Sundays
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays