Free Week Form

Free Trial Week
Class Schedule
Group Fitness

Monday and Wednesday- 5am, 6am, 6:30pm

Tuesday and Thursday - 5am , 6:30pm & 7:30pm

Friday- 6am

Saturday - 8am & 9am

Boxing

Monday Wednesday Friday 5pm-7pm

Youth Fitness

Monday & Wednesday 5pm-6pm
- Important Data Protection
  
  Dream Performance (DP) collects and processes information about gym members. In signing this form, you are giving consent for your personal and sensitive information to be processed under the rules and safeguards laid down.
  
  Dream Performance has procedures in place to ensure that all information held about you will be dealt with confidentially, held securely and only processed in accordance with Dream Performance's notification policy. Dream Performance may wish to contact you for marketing purposes. If you do not wish to be contacted in this way, please tick this box
- Please fill out all necessary details.
- Upon completion of this form, a DP staff member will reach out you.
- Your free week must begin within two weeks of completing this form.
- If there is a membership special running, a prospective client cannot complete a trial week and sign up for the special. However, a client cant opt of the trial week and go right into the special.
Personal Information
Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
City of Residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*

Area CodePhone Number
Email*
When is the best time to contact you?

MorningsAfternoonsEvenings
How did you hear about us

Social MediaWord of mouthSearch Engine
Were you referred by a current DP member or Staff member?

Yes (If, yes complete the field below)No
Name of DP member or staff who referred you?

First NameLast Name
Consent to Exercise
- Exercising is an essential part of maintaining a healthy lifestyle. Some people however are unable to participate fully due
  to illness or other medically restrictive reasons. It is therefore important that the following questions are answered fully and
  honestly to enable us to ensure that our members can exercise safely.
- Please ensure that you sign the declaration below.
- If you are under 18 a parent or guardian must also sign.

	YES	NO
Have you, for any reason, been unable to exercise in the past?
Has your physician ever advised you against exercising?
Have you ever suffered from any cardiac (heart) related illness?
Have you ever suffered from respiratory difficulties?
Have you ever suffered from fainting, migraines or loss of balance?
Have you ever suffered from any bone, joint or muscle related disease?
Is there any history of heart disease in your family?
Have you experienced chest pain whilst exercising?
Do you have high blood pressure?
Do you have elevated cholesterol levels?
Are you currently taking prescribed medication?

PARQ

Physical Activity Readiness Questionnaire
If you answered ‘yes’ to any of the above, please give details below. All information is held in strictest confidence and accessible only by the gym manager and relevant staff.
I confirm that all the answers above are true to the best of my knowledge and I believe I am able to participate in exercise at Dream Performance, LLC.
Signature*
Date*

MonthDayYear
Date
DREAM PERFORMANCE, LLC

6707 Meadowbrook Drive
Fort Worth, Texas 76112

Youth Fitness/Boxing: 682.231.0474

Group Fitness: 682.233.1284

Email: DreamPerformance18@gmail.com

Website: Fwdreamperfomance.com
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Free Trial Week

Class Schedule

Personal Information

Consent to Exercise

PARQ