CORPORATE INTAKE
Today's Date*
Last Name*
First Name*
Company Name*
Company Mailing Adress*
Email Address*
Cell Phone Number *
Company Phone Number*
What is your role at the company?*
What are the comapany's goals?*
Building a strong team culture
Increasing energy at work
Attracting and retaining staff
Decreasing healthcare costs
Staying connected away from the office
Getting employees moving
How big is your comapny? (# of employees)*
Where are you located?*
Do you have a wellness program already?*
Yes
No
Training Availability (Times of the day)*
Morning
Afternoon
Evening
Training Availability (Days of the week)*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Training Program Commitment (Months)*
1-3 Months
4-6 Months
7-12 Months
Training Program Commitment (sesions per week)*
1
2
3
4
5
6
Training Program Start Date*
Payment Options*
Weekly
Bi-weekly
Monthly
Pay in full
Other (payments > Monthly; < Pay in full)
Additional Comments