-
 
 
     
 
 
 
 
 
  
 
 
 
Let's Get Started
 
 In order for us to have a better understanding of what type of program you are looking for, please complete the following  Health Questionnaire below. After you submit the form you can expect a phone call or email within 24 hours to set up your complimentary fitness consultation and "Try-Out!".
 
 
Another Level Sports Performance PAR-Q Physical Activity Readiness Questionnaire
Name of Cient/Athlete
Name Of Parent or Gaurdian if child is under 18
Athlete/ Childs Date of Birth
Gender
M
F
Email address
Emergency Contact Name/ Relationship
Phone/ cell number
Which is your dominate hand?
Right
Left
Ambidextrous * Able to use both "equally"well.
Which is your Dominate foot? *If you were to kick a ball, which would you use?
Right
Left
Sport (Sports) currently participating in.
School/ Grade
Has your doctor ever informed you that you have heart trouble?
yes
no
To the best of your knowledge do you currently have high blood pressure?
yes
no
Have you undergone surgery (minor or major) within the past 2 years?
yes
no
Do you currently have bone or joint problem that may become aggravated with strenuous exercise?
yes
no
Do you have diabetes? If so, what type?
Do you have any concerns about participating in a strenuous training program such as dizziness, fainting, chest pains, pregnancy, low back pain, smoking, current medications, etc.? If so,please explain.
Are you currently taking medication?
yes
no
Is there anything not mentioned above that we should be aware of in order for us to appropriately design a safe and productive training program for you? If yes, please explain.
Congratulations! If you've made it this far, you're well on your way to achieving any goals that you have set for yourself. Your determination and the correct exercise program will keep you motivated and attaining your goals.
 
 
" You will never possess what you are unwilling to pursue"
 
 
 
 
Website Builder provided by Vistaprint