EcoTrek Fitness Participant Profile
This is not a waiver.
You will be presented with a waiver to sign at your first EcoTrek session!
Birthdate (month & day)
(EcoTrek is *FREE* on your birthday! Including the year is not necessary)
Please type both your mailing address (including zip code), your current EMAIL address and phone number - and Series location if it is different than the town in your address!
Everyone is encouraged to “go at their own pace” in the EcoTrek sessions. Please check all that apply:
extremely fit (routinely runs marathons, lives an entirely healthy lifestyle, fit & healthy)
generally fit (occasionally runs in competitive races like 5K or trail runs; currently at desired weight and fitness level)
“I’m healthy but I want more...” (wants to possibly lose a few pounds, tone up, gain more energy, feel more FIT!)
“I’m on the path to fitness!” (have made a conscious decision to eat better, get more exercise, maybe want to lose 10-20 pounds)
fitness level needs work (need to lose 25+ pounds for health benefits, wants to learn more about healthy eating, etc)
I've never done any organized form of exercise
I'm REALLY nervous about this but willing to give it a try
How many times a week are you doing some type of cardiovascular fitness? What type of cardio are you doing? (check all that apply)
once a week
couple times a week
3-4 times a week
5 or more times a week
WALKING - indoors (treadmill, track, etc)
WALKING - outdoors (roads, sidewalks)
WALKING - outdoors (trails)
RUNNING - indoors (treadmill or track)
RUNNING - outdoors
MACHINES AT GYM (elliptical, stairstepper, etc)
OTHER (mention in the weight training field below!)
Are you currently weight training as a part of your exercise program? If you are weight training, are you using bands, free weights or machines?
Do you have a current or past medical condition or injury that we should be aware of? If yes, please explain. Anything else your Series Leader should know? (please include allergies, inhaler usage, etc)
If you are a woman, are you currently pregnant, or is there a possibility that you are pregnant?
Yes - I might be pregnant
Yes - I am definitely pregnant
No - I am not pregnant
Are you currently a "smoker" or do you have a history of tobacco use?
I know what to expect; I have friends/family who attend EcoTrek Fitness sessions.
I understand age is in the mind; but my chronological age falls into this category:
19 & under
60 & up
Do Not Fill This Out