BodySTARR LLC Group Fitness Program Form

BodySTARR LLC Fitness Program

Registration Form must be completed before beginning any type of Fitness Program.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Home Number *

Area Code Phone Number
Cellular Number *

Area Code Phone Number
Work Number

Area Code Phone Number
Birthdate *

Month Day Year
Height
Weight
Occupation
Health Status *

Excellent Good Fair Poor
When was your last physical exam (Should be within the last year) *
What is your Blood Pressure?
Are you Presently on medication for Blood Pressure, if so what is it?
Do you have any health conditions? *

Yes No
If answered Yes, please describe.
Do you take any dietary supplement?

Yes No
If answered Yes, what type?
Do you Presently Smoke?

Yes No
If answered Yes, do you plan to quit?
Should be Empty:

BodySTARR LLC Fitness Program