Train | Vigilantech Boxing

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All Vigilantech programs are for women age 18+

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Are you looking for in-person training, or online training?

In-person at Vigilantech studio in Dunbar, PA

Online sessions

Hybrid

For in-person training, you must be willing and able to come to the Vigilantech studio in Dunbar, Pennsylvania.

Where are you located?

What is the primary transformation you are looking for?

(Fitness, weight loss, discipline, confidence, self-defense, etc.)

Have you boxed before?

Yes

No

Other

Do you have access to a heavy bag?

Yes

No

This is not a requirement for the program, but helps with building a personalized plan for you.

Which commitment would work best with your schedule?

1x Weekly

2x Weekly

3x Weekly

Something else

Are you interested in nutritional information?

Yes

No

Not Sure

If yes, what is your weekly grocery budget?

Please give an estimate of what you spend on food for yourself. Do not include any other family members you may be shopping for.

Has your doctor ever said you have a heart condition or high blood pressure?

Heart condition

High blood pressure

None

Decline to answer

Please check all that apply.

Do you feel pain in your chest when at rest, when you do daily activities for living, or when performing physical activity?

Please check all that apply.

Do you lose balance because of dizziness, or have you lost consciousness in the last 12 months?

Yes, lost balance because of dizziness

Yes, have lost consciousness in the last 12 months

None

Decline to answer

Please check all that apply.

Please answer "no" if your dizziness was associated with over-breathing. Including during vigorous exercise.

Have you ever been diagnosed with a chronic medical condition other than heart disease or high blood pressure? If yes, please list it below.

If "no," please write "none." You may also write "decline to answer."

Are you currently taking prescribed medication for a chronic medical condition? Please list condition(s) and medication(s) below.

If "no," please write "none." You may also write "decline to answer."

Do you currently have, (or had in the past 12 months) a bone, joint, or soft tissue (muscle, ligament, tendon) problem which could be made worse by becoming more physically active? Please list below.

Please answer "no" if you have had a problem in the past, but it does not currently affect your ability to be physically active. You may also write "decline to answer."

Has your doctor ever said that you should only do medically supervised physical activity?

Yes

No

Decline to answer

Please sign below to indicate this information is accurate.

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The signature here is not signing you up for anything, or obligating you to participate in anything at Vigilantech. The information given on this form will only be used to determine if the program is a good fit, and you can participate safely. Your information is not shared or sold.

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