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Please complete the following questionnaire. All responses are confidential.

1.List your top 3 Health and Fitness goals: (Please be specific)

a.

b.

c.
  
2.On a scale of 1-10 (1=Low, 10=High) how serious are you about reaching your Health and Fitness goals?

1 10
  
3.Including you, how many people will be participating in the program? You may have up to four.

  
4.How many days a week are you able to commit to attending class?

  
5.When would you like to get started?

  
6.What are the names and email addresses of your friends?
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