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Agestrong Fitness Application
Please answer all questions in as much detail as possible and then hit that pretty green "Submit" button. I'll get back to you within 1-2 working days.
** These questions are for my purposes only and will never be shared.**
What is your full name?
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What is your email address?
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What is your phone number?
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Please fill in your birth date
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What is your gender?
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A
Male
B
Female
What is your height and weight?
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What inspired you to apply for the AgeWell50+ Method?
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Do you have any existing health conditions or concerns that we should be aware of? If yes, please provide details:
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Have you participated in any similar programs or projects before? If yes, please specify
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A
YES
B
NO
What specific goals do you hope to achieve through your participation in the AgeWell50+ Method?
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How do you envision this program contributing to your overall well-being?
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What motivates you to prioritize your health and well-being?
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Are you willing to invest in yourself financially to turn your goals into your reality?
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A
YES
B
NO
How committed are you to making positive changes in your lifestyle and habits (on a scale of 1-10)?
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0
1
2
3
4
5
6
7
8
9
10
Favorite movie of all time?
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I hereby declare that the information provided in this application is true and accurate to the best of my knowledge. I understand the commitment involved in the AgeWell50+ Method and am willing to actively participate.
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Signature
Date:
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Submit
