Teaching Coaches, Training Champions

Individual Programming Form

Interested in working with our team to reach your goals?

Complete the form below throughout and a member of our team will connect with you to determine the next steps for your journey!

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday

YYYY

Height

Wieght

Normal Weight/ Competition Weight Category

Gender/ Pronouns

Programming Interest

Who is your current coach and do they know that you are inquiring about services with us?

What are your goals for the individual program?

Please describe any medical issues we should be aware of. Including but not limioted to heart or other cardiovascular issues (i.e. high blood pressure, stroke, heart attacks).

Are you taking any medications for heart disease, cholesterol management, blood pressure control, weight loss, or any other condition involving your physical health?

We don’t have before and after pictures, we’re not making claims about magic cures and such. We want you to be stronger, feel better, enjoy life more. And be stronger. Change and discipline work better with support, and we provide that community of support for you.

Do you have any history of joint or bone problems?

Have you ever sprained an ankle, wrist, elbow, shoulder; separated or dislocated a limb/ joint; broken any bones? Have you had surgery to correct any breaks? Have you had any joint replacements? Have you had any surgery to remove any cartilage or repair torn or damaged cartilage or ligaments?

Describe your diet.

Are you using any diet ideology, program, nutrition service or plan? If so, please describe, in general terms, the diet ( for example, Zone, RP Diet, IIFYM, Paleo, Keto, Whole30, etc.)

Describe any previous sports history.

Please list any and all sports played at a competitive level and the level at which you played them. Example: Division 1 Track and Field- Hammer Throw; USA Wrestling- National Age Group Qualifier, etc.

Describe your history with strength training.

What is your background in strength training and/or weightlifting?

How many days per week, and for how long each day, are you able to train?

Back Squat Personal Best

Bench Press Personal Best

Deadlift Personal Best

Clean & Jerk Personal Best

Snatch Personal Best

Clean Personal Best

Jerk Personal Best

Front Squat Personal Best

Power Clean Personal Best

Power Snatch Personal Best

Best Competition Total

Do you have access to the following equipment: Jerk Boxes, a power rack, a prowler and or a pushing sled, or any cardio equipment (treadmill, elliptical, assault bike, etc.

What questions do you have for us?

Liability Waiver

By entering your name below, you acknowledge that you are aware that weight training and strength-based training possess an inherent risk, that YOU WILLFULLY ASSUME any risk associated with remote programming or training and/or other activities or events, and that you RELEASE MICHAEL MCKENNA, of MCKENNA'S GYM, LLC. , AND ALL EMPLOYEES OR PARTNERS ASSOCIATED WITH MCKENNA'S GYM, LLC., FROM ANY LIABILITY INVOLVED IN YOUR PARTICIPATION IN TRAINING.

First Name

Last Name