If you checked YES to the question above, please provide the highest rank you acheived or are currently. If you are a military dependent, type "dependent".
Are you a current or former First Responder or First Responder dependent?
If you checked "YES" to the question above, please type your current or highest rank as a First Responder or if you are a First Responder dependent, please type "dependent".
Round up if you are 1/2 or 3/4 inch above the number, round down if you are 1/4 above the number. For example: I am 5ft 3 and a half inches, so I would report my height as 5ft 4inches.
Current weight in pounds
If you are currently serving in the military or as a first responder, did you "pass" your last physical fitness performance test?
Which statement best descibes your phycial fitness today?
I consider myself VERY physically fit.
I consider myself physically fit.
I consider myself somewhat physically fit.
I consider myself NOT very physically fit.
I consider myself extremely unfit physically.
Which statement best describes your phsycial composition?
I am at a healthy weight and body composition and I want to maintain where I am at right now.
I am at a healthy weight, but I would like to reduce my body fat.
I could stand to lose 5-10 pounds.
I need to lose 15- 25 pounds.
I need to lose 30-50 pounds.
I need to lose 60-80 pounds.
I need to lose 90-100 pounds.
I need to lose over 100 pounds.
Which statement best describes your current eating and drinking habits.
Very healthy, no changes needed.
Somewhat healthy, but I could eat healthier.
I don't have a healthy diet right now, I need to make major changes.
I thought I was eating healthy, but I continue to put on weight.
Please type below what yourfitness and health goals are for your 30 Day Program
Do you currently have any medical conditions or injury that would limit your participation in a fitness and diet plan?
If you indicate "YES", an FTW Cadre Member will call you to discuss these limitations and help determine if our Program can be modified to fit your medical limitations.
Is there anything else you feel like your FTW Cadre needs to know about? If so, list here.