FOM Foundations Cohort Application

This form asks about your health and fitness goals to help you qualify for the next Fit Old Man Foundations cohort. Please answer the questions honestly and make sure you have medical clearance before participating.

What is your full name? *

Email Address

What is your BEST email address?

What is your age? *

Describe your current mindset towards health and fitness. *

What does your current nutrition plan look like? *

Describe your current fitness routine. *

What are your goals for joining the 'Fit Old Man Foundations' program? *

How committed are you to completing the program? *

Very committed Somewhat committed Not committed

Can you commit 3 to 5 hours per week?

Yes No

How do your family and friends support your health goals? *

Do you believe in group accountability? *

Yes No

What challenges do you anticipate in completing the program? *

What is your plan to overcome these challenges? *

Which of the following do you have access to?

Please check ALL that apply.

Google Chrome Safari Google Meet Zoom Google Drive Dropbox Camera for your computer Microphone for your computer Cell phone with camera & mic

Do you have any of the following medical conditions? *

Diabetes Hypertension Heart Disease None

Please list any other medical conditions you have.

Are you medically cleared to participate in a nutrition and fitness program? *

IF you're not sure, please select "Not sure" and we can discuss during your call.

Yes No Not Sure

Disclaimer

Please ensure you are medically capable of undertaking this program. Consult with your healthcare provider before starting any new nutrition or fitness regimen.