Program Questionnaire

General Information:

Name:

Date of Birth:

Address:

City:

State:

Zip:

Email:

Phone:

Please choose up to 3 areas you feel could use improvement in your affiliate & we will customize this month's programming to emphasize those needs. Examples include, but are not limited to:

Strength (heavy weight & low reps)
Gymnastics, aka, bodyweight movements (high volume)
Gymnastics, aka, bodyweight (skill with technical elements)
Cardio Respiratory Endurance (lungs, engine)
Olympic Lifting (clean & jerk, snatch)
Stamina (muscular failure before wind dies or vice versa)
Mobility/Flexibility
Mental Toughness

Other Area(please provide details):

The custom programming we create for your affiliate uses equipment common to CrossFit gyms. Only check the box for equipment you do NOT have. By checking a box on this list we will know not to incorporate that equipment into the programming.

Barbells
Bumper plates
Gymnastics Rings
Pullup bars (for regular pullups & bar muscleups)
Boxes for box jumps
Jump ropes
Kettle bells, 1 pood, 1.5 pood, 2 pood
Rowers
Airdyne or Air Assault bikes
Dumbbells, 25's, 35's, 45's
Glute Ham Developer
Abmats
Climbing rope, 15 feet high
Medicine Balls, at least 14 & 20 pound
Racks for back squats
Flat benches
The ability to incorporate running into workouts

Please describe any unique circumstances we should consider when programming classes at your affiliate? For example, if your affiliate was on the 5th floor of a building in NYC & you were not allowed to drop weights, we would adjust the programming accordingly.

By checking this box, I acknowledge that I have read and accept the terms and conditions associated with this program. (You must scroll to the bottom of the waiver in order to check box)