Name *

First Name

Last Name

Phone *

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What are your fitness goals? *

Choose as many as apply

Improve my posture and/or reduce back pain

Improve my mobility, proprioception (perception or awareness of the position and movement of the body) and balance

Regulate my nervous system and emotions, improve my reaction to stress and calm my mind

Complete a physical challenge, such as a 10km run, triathlon or CrossFit competition

Develop or acquire a new skill, such as a headstand or a muscle-up

Invest in my future self; lay foundations now to safeguard my health and wellness in the future

Be able to keep up with my children, or get down onto floor and back up with ease whilst playing with my grandchildren

Other

Which of the following HOLD fitness modalities are you interested in? *

Choose as many as apply

Yoga

Pilates

Yoga-Pilates fusion

Meditation

Strength and conditioning

Interval training

How much time can you realistically carve out during a regular, routine week for your mind-body fitness practice? *

1 session = 30-60 minutes. Choose one

1 or 2 sessions

3 or 4 sessions

5 or 6 sessions

Which of the following fitness modalities and activities do you currently practice? *

Choose as many as apply

Cardiovascular and endurance training, such as swimming, running, cycling, walking and rowing

Strength and conditioning training, such as traditional weightlifting, body weight strength training, and resistance training

Circuit and/or interval training, including CrossFit

Contact sports and/or martial arts, such as rugby, boxing and Brazilian jujitsu

Team sports such as football, hockey and netball

Adventurous pursuits, such as hiking, kayaking and climbing

Yoga

Pilates and/or barre

Meditation

Dance

Horse riding

Other

Liability Waiver *

Yoga and Pilates are no- to low-impact fitness modalities, and are very low risk in terms of injury. HOLD clients can expect to be guided by a qualified and insured instructor. At the same time, clients take full responsibility for their own health and any illness or injury that may occur, including consulting a doctor or other medical professional before undertaking their yoga and/or Pilates practice. Students will not hold HOLD instructors or locations responsible in the case of accident or illness during practice.

Agree