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First name

Last name

Best phone number to reach you

Email Address (will be a priority form of contact for application process)

Date of Birth (Month)

Date of Birth (Day)

Date of Birth (Year)

Were you referred by anyone? or have a referral code?

What is your occupation?

Are you a part of the agricuture Industry? If not, what industry do you work in?

Business Name

Are you married? If so, what is your spouses name?

When it comes to lifestyle change, do you and your spouse handle those together? (if applicable)

**If your application is accepted, and you answered "yes" to the above question, please make sure to schedule a call when your spouse is also available.

Anything we need to be aware of as far as nutrition goes?

Have you ever worked with a health coach before? (Lifestyle, Personal Trainer, Online Personal Trainer, Mental Health, etc)

Have you taken any action at all to reach your goals?

On a scale of 1-5, how important is it for you to overcome your struggles, obstacles, and current mindset to achieve your goals? *

On a scale of 1-5, how intense are your workouts? (1- my heart rate does not elevate, to, 5- my heart rate is usually up the entire time (45-60 min) *

If we were to work together, what would be the ideal outcome or resolution for you?

What is the reason WHY you are applying for 1:1 coaching today?

What is your biggest obstacle you are facing in your fitness journey, right now?*

I operate only from a "HELL YES" in my life, and eveything ELSE is a NO. If we should get on a call and it's a HELL YES to work together, are you willing to make the investment in yourself to hire a coach?

By enteing my phone number I consent to receive text messages. I understand I may opt out at anytime

Thank you for submitting your application. We will be reviewing it and getting back to you with the status soon. I do respond to ALL applications, even if it's not a good fit, so if you don't receive an email from me in the next 24 hours or so, check your junk folder for me. :)

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Amanda, the mastermind behind it all has devoted herself to providing fat loss programs and next-level fitness solutions to thousands.

P.O Box 64 Sisseton, SD 57262

support@farmfitmomma.com

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