Name *

First

Last

Age *

RPP Training Program *

Please list "Other"

Have you experienced any back pain in the past 6 months? *

If "Yes", please provide brief summary...

Have you experienced any shoulder or elbow pain in the past 6 months? *

If "Yes", please provide brief summary...

Have you experienced any other pain or injuries in the past 12 months? Please specify (N/A if none)... *

What is the current status of your pain or injuries, please summarize (N/A if none)?

Have you ever been diagnosed with Scoliosis (sideways curvature of the spine)? *

Do you have any prior weight lifting experience (with RPP or a professional trainer, *** note - school gym or travel team programs don’t count)? *

If Yes, for how long... *

Any other comments...