Contest Prep Form | Health & Fitness | Nutrition Programs

Name*
First Last
Phone*
Email*
Enter Email Confirm Email
Date Of Birth*
Date Format: MM slash DD slash YYYY
Gender*
Height*
Weight*
% Body Fat
Please describe your short & long term goals?*

What is your current training frequency?*
Training Session Duration*
Please describe your current training protocols and fitness programs*
Does this include any cardio exercise?*
- Yes
- No
How many hours per week?*
Contest Details
Which competition are you training for?*
When is the competition?*
Date Format: MM slash DD slash YYYY
Is this your first competition?*
- Yes
- No
How many shows have you competed in?*
Contest Name*
Placing*
Contest Weight*
Contest Name*
Placing*
Contest Weight*
Contest Name*
Placing*
Contest Weight*
Contest Name*
Placing*
Contest Weight*
Which division are you competing in?*
Which division are you competing in?*
Are you an Amateur or Pro?*
- Amateur
- Pro
Which federations are you affiliated to?*
What was your heaviest weight?*
Preferred Coach?*

How did you hear about us?*
- Website
- Facebook
- Youtube
- Instagram
- Soundcloud
- Referral
Photographs (*
Drop files here or
3-4 pictures of poses from your specific category (bodybuilding, figure, bikini, etc.) (max 10mb's each)
Additional Information
Terms & Conditions*
I have read & agree to the terms & conditions.
With the exception of the Model Release, acceptance of all terms and conditions is required to participate in any program offered by ProPhysique.

GENERAL RELEASE - I agree to allow ProPhysique to design a program for me to use as part of my competition preparation. I will not hold ProPhysique and/or any related persons or parties personally liable for injuries, illnesses or problems that might occur as a result of the program developed for me. This program does not replace the expert advice or medical treatment of a healthcare or medical professional. I affirm that I have provided ProPhysique with all necessary and pertinent information. I take full responsibility for any and all complications, injuries, illnesses or death that may occur as a result of this program.

MODEL RELEASE - Whereas for valuable consideration hereby acknowledged as received, the Model granted ProPhysique permission to photograph him/her and thereafter to use the photographs in whole or in part without restriction anywhere, in any medium, for any purpose and altered in any way. The Model releases ProPhysique from all claims of liability relating to the use of the photographs. This permission and release shall be irrevocable and binding upon the Model's successors, legal representatives and assigns and shall accrue to the benefit of ProPhysique's successors, legal representatives and assigns.

CANCELLATION POLICY - We require a 30 day cancellation notice should you decide to quit services with ProPhysique. you must submit your cancellation to our email address training@prophysique.com. If your billing date falls within the 30 day period we will prorate your fees accordingly.

RELEASE AND HOLD HARMLESS AGREEMENT - I understand that my participation and/or involvement in ProPhysique carries with it the potential for certain risks, some of which may not be reasonably foreseeable. I further acknowledge that these risks could cause me, or others around me, harm, including, but not limited to, bodily injury, damage to property, emotional distress, or death. I am a willing participant in any and all ProPhysique activities, events, programs. By signing this agreement, I agree to release, indemnify, and hold harmless ProPhysique, as well as all its employees, agents, representatives, successors, etc. from all losses, claims, theft, demands, liabilities, causes of action, or expenses, known or unknown, arising out of my participation in any and all ProPhysique activities, events, programs.
Newsletter Subscription
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Email
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