Pilot Fitness Program Interest Form

Thank you for your interest in joining our free 4 week pilot program! We are building a community of women in midlife and beyond who are interested in adding strength, agility and balance to their current fitness routine, or beginning a new exercise program. Our goal is to help you build muscle and bone strength.

The pilot program will consist of strength, agility and balance exercises with conditioning goals sent directly to you via email or text message each week. Exercises will link to videos and detailed instructions to help ensure understanding and reinforce proper form. The initial fitness program will be offered to you at no charge, and no credit card is required.

Once the 4 week program is complete, you will have the option of continuing with the program. We will check in with you and solicit your input as to various aspects of the program. The pilot will launch in Spring 2025.

Please complete the information below to help our team develop a program that meets your needs. We will be in touch soon with more details.

A limited number of applications for the pilot are available – so please sign up quickly if you are interested!

Read more about us and our mission.

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Name *

First

Last

completed goal(s) program?

Email *

What is your current level of fitness? *

• I don’t participate in any fitness activities
• I do some activities, such as walking, hiking, running and/or playing a recreational sports
• I’m pretty active

Please select your goal(s) for joining our pilot fitness program: *

• Increase strength
• Increase balance and agility
• Increase stamina
• Control weight
• Sleep better
• Better mental well being
• Increase bone health
• Increase confidence in daily tasks

We recommend the Strength, Agility and Balance portion of our program be completed 2-3 days per week. How much time are you able to put aside 2-3 days a week for this program? *

• 15 – 30 minutes every few days
• 30 – 45 minutes every few days
• My days are variable, and I need a program that will let me fit in 5-10 minutes here and there

Do you have access to weights for lifting exercises? *

• No, I don’t have access to weight equipment. I need a program I can do with household items
• No, but I would be willing to make a small investment (<$100) in some equipment
• Yes, I have access to weights

What is your age range? *

• Under 40 yrs
• 40 – 50 yrs
• 50 – 60 yrs
• 60 – 70 yrs
• Over 70 yrs

Anything else you would like to tell us about regarding your fitness objectives and needs?

Submit