Gym Application Form

Limited Memberships Available

We are a personalized gym providing personalized coaching and a gym-family atmosphere that's unique. To give our members as much individual attention as possible, we've limited the number of memberships available. Please fill out the form below and we'll contact you as soon as possible to schedule a free consultation and tour.

Why Are You Applying?

Please describe WHY you want to become a healthier version of yourself. What is your main motivation? Relationships? Activities you want to enjoy? How you feel? Don't be shy... this is confidential and helps us tailor the right plan for you.

When was the last time you remember feeling your best, being at your ideal weight or size, or performing the way you want in your activities?

What has kept you from reaching your goals in the past?

What makes this time different?

What's Important to You?

Please rank each of the following on a scale of 1-10, with 10 being the most important.

Improve Cardiovascular Fitness

Body-Fat Weight Loss

Improve Performance for a Sport

Improve Flexibility

Increase Energy Level

Increase Strength

Enjoyment

Feel Better

Reduce Stress

Improve Muscle Tone

Lose Weight/Inches

Gain Weight / Muscle

Improve Quality of Life

Other Motivation

Activity Level

How would you rate your daily energy level on a scale of 1 (lowest) to 10 (highest)?

What physical activities do you participate in?

Do you currently exercise? If so, how many times a week?

How would you describe your daily activity level?

in How Muscle

What activities are you not performing the way you'd like to, that you want to improve your performance in?

Stress

How would you rate your stress level on a scale of 1-10? (10 = highest)

What are the stressors in your life, if any?

Weight Loss

What has been the most difficult thing about losing weight in the past?

Is there anyone in your life who is empowered to get healthy with you?

Your Contact Information

Name *

First

Last

Phone Number *

Your Age *

Email *

How motivated are you to start? On a scale of 1-10 with 10 = Highest *

How did you hear about SCE Fitness? *