vip-sign-up-form – Jake Campus Nutrition

You are about to begin your VIP online consultation with Jake.

I am diving in to understand your current diet, exercise, and most importantly GOALS. You will be required to set up your payments before submitting your details. Please ensure you have read the terms and conditions of the program before submitting.

Personal Details

Date*

Age requirements*

I am 18 or over

It is company policy to be over the age of 18 to participate on our online program.

Age

Gender*

Please only select one option

Do any of the following apply to you?*

Please only select one option

How long have you been breastfeeding for?*

Please submit a front and back full photo for us to see your body composition. We will use photos throughout our journey to track your performance and results.

Front photo*

Max. file size: 100 MB.

Back photo*

Max. file size: 100 MB.

Name*

First Last

Email*

Height*

Write number only in Cm

Weight*

Phone*

Country*

NZ = New Zealand, AUS = Australia, INT = International

International country

Which country do you live in?

Is this your first time working with us?*

What Jake Campus programme were you on and how long ago?*

Are you doing this programme with anyone else in your house hold?*

Is your partner or flatmate on this journey with you and also following a plan? If so let us know we can work plans in together to make prep in the house hold easier.

What is their name?*

Medication, Illness, Intolerances & Allergies

We need to dive deep into your current health so we can know all the factors that contribute to your diet. Remember I the terms and conditions we do recommend having a medical checkup. Whether you choose to do so or not is your decision.

Are you allergic or intolerant to any foods?*

Yes
No

Please explain the intolerance or allergy and its affects*

Are you taking any medication or suffer from any illnesses?*

Yes
No

Please explain medication or illness*

Have you ever experienced or currently have an eating disorder?*

Please only select one option

Please describe this in further detail:*

What style of VIP Nutrition are you looking to be coached in?

Let’s start by understanding the approach you’d like to your nutrition.

What type of VIP Nutrition are you looking for?*

You can only select ONE option. This will determine your VIP approach with us.

By choosing the weekly accountability – we need you to be fully committed to the program. On this program, we require weekly check-ins and an exercise regime to be followed.

What federation are you looking to compete in and what is the show date?*

Is this your first body building prep?*

YES
NO

Please explain your past preps, what division you are competing in and what you are looking to achieve from this one?*

This information will help us customize the approach we take with your prep to get you in the best condition possible!

Please describe what your knowledge is around starting a prep and what division you look to compete in?*

This will help us educate you on the prep steps we need to take to achieve the best condition.

Please explain your sport and what you wish to achieve from doing a performance plan with us?*

Are you looking to peak / what are you main competition or events coming up?*

Tell us why you have chosen to check in weekly and what you are looking to achieve from this approach. Please be specific with your goal.*

Physical Activity

We need to understand what type of physical activity you are currently doing or able to get into your day to help us build a plan to achieve your goal.

Explain your current exercise regime; Frequency, time of day, duration and type of training/ splits.*

How many exercise sessions can you fit in per week?*

What equipment do you have access too?*

Current Diet & Habits

Be honest and let us know everything! Foods you like, dislike, current habits and anything else we should know. The more information the better we can work with to create the best plan for you.

Foods you like?*

Foods you dislike?*

Do you use supplements in your diet?

Yes
No

In our programme some supplements can be great for your diet, is this something you are open too?*

Yes
No

Please tell us what products and when you are using them. If you are not using a protein supplement are you open to introducing one?*

Yes
No

Do you track macronutrients?*

Yes
No

You are not required to do this on our program, however if its something you are currently doing and plan to keep doing we will use this tailor our approach to fit!

How do you track your macros and what is your current split?*

How much alcohol do you consume per week?*

Current Food Diary

Please write down everything you eat and drink including the time and quantities. Do not try to change your eating habits during the Three Day Food Log.

Average Week Day

What is your go to Breakfast and what time do you have Breakfast?*

What do you have for a morning snack and what time do you have it?*

Whats a typical lunch and what time do you have it?*

What do you have for a afternoon snack and what time do you have it?*

What is your typical dinner and what time do you usually have it?*

Do you eat anything after dinner? If so what is it?*

Average Weekend diet

Weekends can tend to differ to our weekly diet as we may be out and about, away from home, indulge in eating out or your diet may be the same as your weekday.

Please explain your weekend diet and eating times for us:*

Please read carefully before proceeding to the next step of your application.

VIP PROGRAM TERMS AND CONDITIONS*

I understand and agree to the terms and conditions stated below

Acknowledgment
Please read the following and tick before proceeding to payment.
By accepting these terms you agree and understand ALL the risks and assume liability for your own health and potential future risks associated with partaking in any exercise and nutrition plan and in certain cases fat loss and Body Building.

You understand that Jake Campus Nutrition will provide support and advice governed by your updates and online communication. If you have concerns with your recommendations or health you understand the importance and will disclose concerns immediately with Jake Campus Nutrition and a doctor.

Jake Campus Nutrition recommends ALL clients have a medical checkup prior to starting a nutrition program. By ticking below you understand it is your responsibility whether or not you choose to have this checkup. Any relevant results from the medical assessment must be passed onto Jake Campus Nutrition.

The Jake Campus Nutrition team are not Medical Physicians, they consult and recommend nutrition services only. If you have future queries or concerns regarding your meal plans or health you agree to inform Jake Campus Nutrition immediately. For medical advice, you should consult with your doctor and share results with Jake Campus Nutrition. Questions or concerns are to be emailed to info@jakecampusnutrition.com and NOT shared to any social media platforms. By signing up to this program you agree and understand that any slander of Jake Campus Nutrition on Social Media can cause defamation to the company.

JCN Terms and Conditions
By accepting this you understand this program is a roll-over program and commit to 20-weeks of the program in which 20 payments of $125 AUD will be billed. Regardless of whether you participate or choose not to continue, you are legally liable to make the 20 payments as the price is based on your coach’s weekly rate and your spot is secured for them at that time. All sales are final. Refunds will not be processed if the service is not being used.

Cancellations require 7 days’ written notice.
For your convenience, all payment plans rollover after the allocated time frame so you can continue to use our services and update your plans. If you wish to cancel after your compulsory payments are complete, please email us 1 week in advance to shut your account down. Initial set up/call/plans are valued at $500.00 AUD and updates are valued at $100.00 AUD. Should your account be cancelled down within your minimum term at our discretion you will be required to pay for the value of the services received.

All JCN online programs are for ages 18+by signing up you consent that you are 18 or over. If you seek nutritional advice and you are under the age of 18 you must contact our customer support team to discuss our options.

I COMMIT TO THE FOLLOWING STATEMENT

I have provided accurate information to my coach and commit to my goals moving forward. I commit to my weekly checkins and providing open honest communication with them in order to achieve the best outcome.

Welcome to the VIP Program with Jake Campus

VIP Subscription Form NEW

You are about to begin your VIP online consultation with Jake.

Personal Details

Medication, Illness, Intolerances & Allergies

What style of VIP Nutrition are you looking to be coached in?

Physical Activity

Current Diet & Habits

Current Food Diary

Average Week Day

Average Weekend diet

Welcome to the VIP Program with Jake Campus

VIP Subscription Form NEW

You are about to begin your VIP online consultation with Jake.

Personal Details

Medication, Illness, Intolerances & Allergies

What style of VIP Nutrition are you looking to be coached in?

Physical Activity

Current Diet & Habits

Current Food Diary

Average Week Day

Average Weekend diet

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