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GKTC Intake Form

This application gives us an idea of where you are at in your fitness and kettlebell journey, including your lifestyle and goals.

Click the button below to start.

Start

BACKGROUND

   

Question 2 of 22

First and Last Name

Question 3 of 22

Mailing Address (including street address, city, state, country and zipcode)

Question 4 of 22

Best Phone Number

Question 5 of 22

Instagram Handle and/or Facebook Name

Question 6 of 22

Date of Birth*

Question 7 of 22

Email address*

Question 8 of 22

How did you hear about GKTC (Group Kettlebell Teacher Certification)?*

Question 9 of 22

Current Relationship Status:

A

Single

B

Single w kid(s)

C

Married

D

Married w kid(s)

E

Divorced

F

Dating

G

Other

Question 10 of 22

What's your profession? 

Question 11 of 22

Which of the following best describes you:

(Select all that apply)
A

I own a BJJ academy

B

I own a fitness facility

C

I am a personal trainer

D

I am a BJJ practitioner

E

I don't do BJJ, but I am a martial artist of a different style

F

I'm an avid fitness enthusiast looking to build my resume

G

I'm looking for a kettlebell certification for my personal use

H

I'm looking for a kettlebell certification to monetize and use as a business

Question 12 of 22

Are you within (1) hour of my location?

A

Yes

B

No

Question 13 of 22

Medical Information:

(Select all that apply)
A

High blood pressure

B

Low blood pressure

C

Pacemaker

D

Diabetes/Pre-diabetes

E

Stroke

F

Respiratory Disorders

G

Hernia

H

Hearing Difficulties

I

Blood Disorders

J

Epilepsy

K

HIV

L

Liver Disorders

M

Urinary Incontinence

N

Thyroid Problems

O

Heart Condition

P

Cancer

Q

Metal Implants

R

Kidney Disorders

S

Migraines

T

Vision Impairments

U

Cholesterol

V

Birth Control/IUD

W

Anxiety/Depression

X

PCOS/Endometriosis/Fibroids

Y

None

Question 14 of 22

Explain all checked:
(write N/A if none applies)

Question 15 of 22

Medications, currently taking:
(write N/A if none applies)

Question 16 of 22

Major Surgeries? (If yes, please describe)

Question 17 of 22

Do you have any NECK, BACK or JOINT pain? (If yes, please describe)

FINAL QUESTIONS

  

Question 19 of 22

In a few words, how would you describe yourself as a person?

Question 20 of 22

Below are the three elements to our mission at GKTC; please select which part of our mission resonates with you most:

(Select all that apply)
A

To create a kettlebell community that encompasses and empowers all levels of fitness for all walks of life.

B

To give back to the jiu-jitsu community looking to maximize their existing space - ensuring their survival, while continuing to make a positive impact in their communities.

C

To make a global imprint in the health and wellness industry as leading experts in kettlebell fitness.

Question 21 of 22

This program requires your undivided commitment for 8 weeks. Knowing that, how committed are you in becoming one of the best kettlebell instructors in your area?

A

I am 110% ready to get started and make a change in my life!

B

I am about 80-90% committed, but I'm afraid to take the leap..

C

I want to but I'm just not sure if I can do it

Question 22 of 22

Any additional info that I should know?

Confirm and Submit