Online Coaching Application Form

Below is an application to apply for one of my coaching programs. Why do you have to apply? The truth is – we may not be a good fit for each other. That’s okay! This helps me get an idea of whether I would be a good coach for you or not. If so, you’ll get an email from me with instructions on how to get started. If not, I’ll let you know that, too. Regardless, you should hear from me within 24 hours.

Fill out the application below and be detailed. The more I understand about you the better.

Just want to ask me to ask a question? Flick me an email info@empowermefitness.co.nz.

Application Form

First Name *

Last Name *

Email *

Age *

Phone Number *

How many children do you have & how old are they? *

In your ideal life, how would you look and feel? *

What is your biggest obstacle to achieving that life? *

What exercise/activity have do you currently do? *

Have you had a coach or trainer before? *

If yes, what did you like about the experience? If no, what do you expect from a coach? *

If you could have an unlimited supply of one food or drink, what would it be? (p.s. mine is chocolate) *

If you could travel anywhere in the world today, where would you go? (Japan in Winter for me!) *

What do you think my coaching can help you achieve? *

On a scale of 1-10, how committed are you to achieving your fitness goals? *

Are you prepared to invest $100-$250/month for coaching to change your life? *

Yes - Let's do this!

Let's chat! I'm open and need more information.