SayPro Fitness Assessment Form: A baseline fitness assessment to track initial fitness levels, health status, and any pre-existing conditions that may impact participation

SayPro Fitness Assessment Form

Purpose:
The SayPro Fitness Assessment Form is designed to provide an initial evaluation of each participant’s fitness levels, health status, and any pre-existing medical conditions that could impact their participation in the SayPro 5-Day Fitness Boot Camp. This form is a crucial first step in ensuring a safe and effective fitness journey for each participant. It will allow fitness trainers to customize workout plans, make adjustments for individual needs, and monitor progress throughout the boot camp.

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Participant Information:

• Full Name: ___________________________
• Age: __________
• Gender: __________
• Contact Information:
  • Phone Number: ___________________________
  • Email Address: ___________________________
• Emergency Contact Name: ___________________
• Emergency Contact Phone Number: _______________

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Health History and Pre-Existing Conditions:

Please answer the following questions to ensure we are aware of any health concerns or medical conditions that could affect your participation:

1. Do you have any of the following conditions? (Check all that apply)
   • Heart disease
   • High blood pressure
   • Diabetes
   • Asthma or respiratory issues
   • Joint problems or injuries (e.g., knee, back, shoulders)
   • Recent surgeries or medical procedures
   • Other medical conditions (please specify): _______________________________
2. Are you currently taking any medications?
   • Yes (please list): _____________________________________________________
   • No
3. Have you had any previous injuries or surgeries related to physical activity?
   • Yes (please describe): _______________________________________________
   • No
4. Do you have any allergies or sensitivities that we should be aware of?
   • Yes (please list): _________________________________________________
   • No
5. Do you experience any of the following? (Check all that apply)
   • Dizziness or fainting during or after exercise
   • Shortness of breath or chest pain during physical activity
   • Nausea or headaches after exercise
   • Unexplained joint pain or swelling
   • Other (please specify): ________________________________________________

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Current Fitness Level:

Please answer the following questions to help us assess your baseline fitness:

1. How would you describe your current physical activity level?
   • Sedentary (little to no exercise)
   • Lightly active (light exercise 1-3 days/week)
   • Moderately active (moderate exercise 3-5 days/week)
   • Very active (intense exercise 6-7 days/week)
2. How often do you currently engage in exercise or physical activity?
   • Never
   • Occasionally (1-2 times a week)
   • Regularly (3-4 times a week)
   • Frequently (5 or more times a week)
3. Which types of physical activity do you currently participate in? (Check all that apply)
   • Walking
   • Running
   • Strength training (weights or bodyweight exercises)
   • Yoga/Pilates
   • Cardio (e.g., cycling, swimming, aerobics)
   • Other (please specify): ______________________
4. Do you participate in any sports or recreational activities?
   • Yes (please specify): ___________________________
   • No
5. What is your primary fitness goal for participating in the 5-Day Boot Camp? (Check all that apply)
   • Increase strength
   • Improve cardiovascular fitness
   • Weight loss
   • Build endurance
   • Improve flexibility
   • Injury rehabilitation/prevention
   • Overall health and wellness
   • Other (please specify): ________________________

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Physical Fitness Tests (Optional, for baseline measurement):

These optional assessments will help track your progress over the 5-day boot camp:

1. Resting Heart Rate: (Measured while sitting quietly for 5 minutes)
   • ____________________ bpm (beats per minute)
2. Body Measurements:
   • Height: ____________________
   • Weight: ____________________
   • Waist circumference: ________________
   • Hip circumference: ________________
3. Body Fat Percentage (If applicable, or estimated using skinfold calipers or body composition scale)
4. Strength Test:
   • Push-ups: (Maximum reps in one set) __________________
   • Plank hold: (Time held in seconds) __________________
   • Squats: (Maximum reps in one set) __________________
5. Flexibility Test:
   • Sit-and-reach test: (Inches or centimeters reached) __________________
6. Cardiovascular Fitness Test:
   • 1-Mile Walk/Run Test: (Time in minutes/seconds) __________________
   • Step Test: (Number of steps or heart rate recovery rate after 3 minutes of stepping)

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Additional Information:

1. Are there any other factors, conditions, or concerns that we should be aware of?
   • Yes (please specify): _______________________________________________
   • No
2. Do you have any special dietary needs or restrictions?
   • Yes (please specify): _______________________________________________
   • No
3. Would you like to receive nutrition and wellness guidance during the boot camp?
   • Yes
   • No

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Consent and Acknowledgment:

By signing below, I acknowledge that the information provided above is accurate to the best of my knowledge. I understand that participation in physical activities may involve a risk of injury, and I consent to the participation of the SayPro 5-Day Fitness Boot Camp. I agree to follow the guidance provided by the fitness trainers and understand that modifications to exercises can be made based on my fitness level or pre-existing conditions.

• Participant’s Signature: ___________________________
• Date: ___________________________
• Trainer’s Signature: ___________________________
• Date: ___________________________

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This Fitness Assessment Form ensures that the SayPro 5-Day Fitness Boot Camp is tailored to each participant’s individual fitness level, health status, and goals, creating a safe and effective program that helps participants achieve optimal results.