What is Performance Exercise
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Shelia Burrell
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Conact SheBe Gold Athletics
Call at 619 852 9115
Name:
Date Of Birth:
Age:
Yrs. Height:
inches.
Weight:
lbs.
Address:
City:
State:
Zip:
Phone :
Email:
Occupation:
Which Class would you like to take?
9 : 00 AM
10 : 30 AM
1.
How would you describe your attitude toward exercise?
This means any type of exercise, not just limited to the gym. This includes all sporting activities and walking.
A.
Hate it all.
B.
Love working out.
C.
Don’t really like physical activity but know I need to do it.
D.
Would love to workout more if I had more time.
2.
How would you describe your overall health right now? This refers to your Spirit, Soul and Body?
A.
I’m very healthy.
B.
I feel my health is average.
C.
I feel I am in poor health.
3.
How often do you exercise?
A.
1-2 times a week.
B.
3 times a week.
C.
4 or more times a week.
4.
Do you have a gym Membership?
A.
Yes.
B.
No.
5.
How would you characterize your lifestyle?
A.
Highly Stressful.
B.
Moderately Stressfu.
C.
Not Very Stressful.
6.
Have you ever had or do you currently have a personal trainer?
A.
Yes.
B.
No.
7.
What is your main reason for working out? (Circle all that apply).
A.
To Lose Weight.
B.
To Relieve Stress.
C.
To feel good about myself (confidence).
D.
To prevent or decrease degenerative health conditions (i.e. high cholesterol, heart conditions, diabetes etc.).
E.
To get in shape and look fit.
F.
For better mental focus.
G.
Other
8.
How did you hear about SheBe Gold’s P.E. Class?
9.
Would you take this class during the week? If you answered “yes” what times of day would you take it?.
A.
Yes.
B.
No.
If Yes then When?
10.
What did you like about your P.E. Class?
11.
What didn’t you like about your P.E. Class?
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