Personal Training Interest Form

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Please fill out this form and Gene or a personal trainer will be in touch.

First & Last Name *

Primary Phone # *

Contact Email *

Todays Date

YYYY

Date Of Birth *

YYYY

Trainer Preference *

If you have the name of a specific preferred trainer, please list in OTHER.

No preference

Female Trainer

Male trainer

Other:

Preferred Training Times *

Mornings

Afternoons

Evenings

Any Time is Good

Current Exercise Level *

1-3 times per week

3-5 times per week

5-7 times per week

Fitness Goals *

Weight Loss

Improve Strength

General Health

Competition, Performance, Sport Specific

Injury Recovery

Other:

Do you have a current Rec Center Membership? *

Yes, an Annual Adult, Senior or Family Membership

Yes, a Silver Sneakers, Renew Active, or Silver & Fit Membership

Yes, a 3 month or punch pass

No, I don't have a current membership

Please let us know anything else that might pertain to your goals, fitness level, trainer preference or style. (Basically anything else) *

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