Transformation Wellness Group

First Name

Last Name

Phone Number

Birthdate

Gender

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

What is your preferable workout Time

Morning

Afternoon

Evening

Current Level of Physical Activity

Light

Moderate

Intense

Have you completed the Blueprint for Wellness Biometric Exam?

Yes

If you have not completed the Biometric Exam within the past 6 months, click here to schedule your exam with the nearest Quest Diagnostics Patient Service Center.

Are you comfortable with sharing and setting goals within a group or with an accountability partner?

What are your personal Transformation Goals?

What are your expectations of participating in the Transformation Wellness Group?

Team Participation and Liability

An important part of our team is consistent team participation! We need all of our team members to commit to setting an appropriate health and wellness .

I hereby waive all claims for damages or injuries against Impact Church its staff, volunteers and coaches.**

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