Pre-Screening Training Questionnaire

Kindly take the time to fill out the health and fitness questionnaire below. It's purpose is to give healthy teens an indication of your current state of health, training requirements as well as fitness goals! Please be as detailed as you can. The more information you provide, the clearer your state of health will be for me to assess.

Your name (this field required)

Your e-mail address (this field required)

Gender (this field required)

How did you hear about healthyteens?
School brochureSchool flierSchool meet and greetSchool websiteRecommended by a friendInternet Search

What is your age?

What is your height in centimeters?

What is your weight in kilograms?

*What year level are you in? (please select one)
Year 7Year 8Year 9Year 10Year 11Year 12I am a TeacherI am a parent

How would you describe your current physical lifestyle?
Little to no exerciseLight exercise (1–3 days per week)moderate exercise ( 3-5 days per week)Strenuous exercise (6–7 days per week)

*How would you best describe your body type? (please select one)
Ectomorph - your body type is thin with very little body massSkinny with body fat - Your body type is slim with adipose tissue on topMuscular/toned with a few kilos to lose - It's time to shred/tone upMesomorph - Your body is muscular/toned. You've trained in the pastModerate - Your body is framed with an adequate amount of body fat for your buildEndomorph - You have a soft round build with a high proportion of fat tissueObese - By strict definition you are overweight with an abundant amount of body fat

What is your training experience to date? (please select one)
Novice - You have little or no experience when it comes to exerciseLittle experience - I've played around sporidically with weight before. No goalModerate experience - I've trained before and have a general idea about weights and weight lossExperienced - I've trained for a goal before and know what is takes to get there

On a scale of 1-10, how fit are you? (please select one)
Sedentary - I'd struggle to be able to complete a 2 minute walkLight Intensity - I'd get puffed after a 2 minute walk (brisked pace)Light/Medium Intensity - I'd get puffed after a 2 minute slow jogModerate Intensity - I'd get puffed after a 2 minute medium paced jogModerate/Fit Intensity - I'd get puffed after a 2 minute runVigorous Intensity - I'd get puffed after a 2 minute run (fast paced)

What goals would you like to kick-start with Healthyteens? (Select applicable boxes)
↑ Increase my fitness↑ Muscular strength↓ Body fatLose a pants/dress sizeLearn new skillsWeight management↑ Sense of well being↑ Muscle Tone↓ stress levelsIncreased awareness in anxiety managementPre season trainingLift heavier weights↑ Self esteem↑ Aerobic enduranceStrengthen specific areas↑ Energy

What commitment are you willing to make in order to improve your health and fitness?
Set aside time to trainEnsure I eat rightBuild a support networkMonitor and record my progressCommit to training and be accountableSet and stick to short term goalsAlign my attitude towards my goalsUndertake and stick to a lifestyle plan (Diet. Exercise. Mindset)

From 1 to 10, kindly indicate how much you BELIEVE you can achieve your short term goals (1- not confident. 5- moderate. 10- extremely confident)?

In a typical week, how many days can you commit to resistance training?
3 days4 days5 days

What kind of training facilities do you have access to on a regular basis?
School gymLocal gymHome equipmentLocal parks with exercise equipment

Males - Which body parts do you want to focus on?
ChestTricepsDeltoidsBack MusclesBicepsTrapeziusForearmsButtocksHamstringsQuadricepsCalf MusclesCore and abdominal musclesAll body parts

Females - Which body parts do you want to focus on?
ChestArmsShouldersBack MusclesArmsButtocksThighsCore and Abdominal musclesAll body parts

What is your long term weight loss/muscle gain?

Realistically, when do you want to achieve your long term goals by?
0 - 3 months4 - 8 months8 - 12 monthsMore than a year

What would you identify as the main barriers that prevented you from achieving your goals in the past? (Select applicable boxes)
ProcrastinationLack of motivationNo one to be accountable toNo timeLack of facilitiesInjuryLack of ability/fitnessFinancial costLack of relevant knowledgeFamily responsibilitiesMedical adviceNot finding the right trainer

Which healthy teens program are you considering?
Resistance weightsHome workoutsLove to run

Do you have any condition that you'd like me to be aware of?

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