Fitness Services Request Form
If you would like to register for any Fitness Services, please complete the form below and a Wellbeing staff member will process your request using your wellness dollars. You will receive a confirmation after your request has been processed.
After you have completed this form and your request has been processed, you will be contacted by the Fitness Coordinator, Chelsea Finch, to complete a health-fitness questionnaire. Please complete and fax questionnaire to 831-3303 or drop off at our office at CSB 124. Once received and reviewed, Chelsea will connect you to one of our Nationally Certified Personal Trainers.
If you are ineligible for Wellness dollars or do not have any more, you must purchase your package at the CSB cashier or front desk or purchase online at
. The fitness Coordinator will confirm your transaction and complete the process read above.
For all questions, please email
or call (302) 831-8388.
UD ID #
Part Time/Miscellaneous Wage
I would like to register for: (Check all that apply)
3 Express Personal Training Sessions (30 minutes each)
5 Express Personal Training Sessions (30 minutes each)
10 Express Personal Training Sessions (30 minutes each)
1 Personal Training Session (60 minutes)
3 Personal Training Sessions (60 minutes each)
5 Personal Training Sessions (60 minutes each)
1 Fitness Assessment (60 min)
1 Fitness Assessment/ Personal Training Session (60 min each)
1 Fitness Assessment/ 3 Personal Training Sessions (60 minutes each)
1 Know Your Numbers Biometric Health Screening (15 minutes)
1 Body Fat Test (15 minutes)
By checking 'I agree' you authorize an Employee Health & Wellbeing staff member to process your request using your Wellness Dollars. In the event you do not have enough Wellness Dollars, you will be contacted for an alternate form of payment. Once your registration has been processed in our new system, you will receive a confirmation email.
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This form was created inside of University of Delaware.