New Student Inquiry

Are you ready to think and move like a samurai?

If you are ready to dedicate yourself to study martial arts, fill out the new student inquiry form below to see if we’re a good fit.

STEP 1: Let’s get started!

Tell me a little bit yourself by filling out this first part of this form.

~Sensei JEFFREY GALLARDO

Name

First Name

Last Name

Number

What is your Instagram and Facebook handle?

What are your short and long term goals?

How serious are you about reaching your goals?

Not too serious - just fun to ponder it

Serious - I want to start but don't know how.

Very serious - I already started mentally and need more help

Tell me about your primary goals.

Have you ever worked with a trainer or coach? If so, can you tell me more about your experience with your previous trainer or coach?

Do you enjoy working out?

How often did you workout in the past?

What type of workouts did you enjoy in your past?

Did you have any fitness goals in your past? What did you do to achieve these past fitness goals?

Has anything stopped you from achieving your goals? If so please share.

Have you had any major surgeries in the past 20 years? If so, please share.

STEP 2:

Please fill out 2nd part of this form which will tell me more yourself so I can see if you qualify for a complimentary training session.

~Sensei JEFFREY GALLARDO

Name

First Name

Last Name

What are your vices?

Ex: processed sugars (candy, ice cream, etc.) processed sodium (chips, fried foods, etc.), over eating, bar or social scene, drinking with friends, playing video games, watching TV or movies, news channel, dating apps, scrolling through social media, porn, casinos, online gambling, pills to make you feel better, shopping, any kind of smoking (vaping, hookah, cigarettes, cigars, weed, etc.)

Please explain how often do you use these vices on a regular or weekly?

How often do you dine out?

What would be the most important criteria for your success as we work together?

1-10 Rate your current stress level these days

1 - meaning my life is so stressful I cannot even get out of bed, and don't want to do anything about it 10 - meaning my life is great I wake up at sunrise and ready to enjoy life's challenges

1-10 Rate how you feel in your body.

1 - meaning I'm perfectly fine where I'm at now 10 - meaning I'm willing to do anything to reach my goals

1-10 Rate your health priority to change for a better version of yourself

1 - I won't give up my vices (booze drinks, vape pen, video games, shopping, fried foods, etc.) 10 - I'm willing to kill the old me and earn the best version of myself

1-10 Rate how important it is for you to achieve your health goals?

1 - When it gets too hard, I'll go back to my vices 10 - I know it will be hard , but I must let go of my vices, and I will not give up on myself.

What does it mean to achieve your goals?

Does your spouse or significant other support you?

Are you willing to make a financial investment to achieve your goals and improve your health?

Are you willing to cut back on spending money on your vices to achieve your goals?

What would you expect from me as your coach if we decided to work together?

I work with only a few clients at a time because I give quality service not value service you get what you pay for. So I want to make sure we are a good fit. Why do you think you would benefit from a call or be a good addition to our membership if invited?

If accepted how soon will you be ready to move forward and get started?

If you are not ready please just wait and schedule when you can. I expect those who feel it's a fit to move forward. Those who don't take actions are 95% more likely to continue to do nothing.

Will you show up on time?

If not don't waste my time. Time is the only commodity we can't make more of or every buy back one it's spent. Value our time and show up on the time you pick for your appointment.

14th Century Japanese Samurai Poem

I have no divine power

I make honesty my divine power

I have no home

I make awareness my home

I have no parents

I make earn and the universe my parents

I have no friends

I make my mind my friend

I have no life or death

I make the tides of breathing my life and death

I have no enemy

I make carelessness my enemy

I have no armor

I make benevolence my armor

I have no castle

I make immovable - mind my castle

I have no sword

I make power of the mind my sword

Do you have what it takes to live the life of a samurai in today’s modern world?

The idea of living like a true samurai sounds awesome, but are you ready to kill the old you to become the new you? Think about it now. It all has to do with your mindset and how you program yourself to pursue desires. You’d might have to cut back on these things you indulge : drinking, processed sugars, video games, TV, news, dating apps, porn, casinos, social media, pills, etc. Not everyone is ready to give it up and we’re not here to judge. We’re here to help kill the old you and become the best version of yourself.

New Student Inquiry

Are you ready to think and move like a samurai?

If you are ready to dedicate yourself to study martial arts, fill out the new student inquiry form below to see if we’re a good fit.

STEP 1: Let’s get started!

Tell me a little bit yourself by filling out this first part of this form.

~Sensei JEFFREY GALLARDO

STEP 2:

Please fill out 2nd part of this form which will tell me more yourself so I can see if you qualify for a complimentary training session.

~Sensei JEFFREY GALLARDO

14th Century Japanese Samurai Poem

I have no divine power

I make honesty my divine power

I have no home

I make awareness my home

I have no parents

I make earn and the universe my parents

I have no friends

I make my mind my friend

I have no life or death

I make the tides of breathing my life and death

I have no enemy

I make carelessness my enemy

I have no armor

I make benevolence my armor

I have no castle

I make immovable - mind my castle

I have no sword

I make power of the mind my sword

Do you have what it takes to live the life of a samurai in today’s modern world?

Location

Hours Available for Private Training (APPOINTMENT ONLY)