Personal Training Request

Name (required)

Email (required)

Phone

Age

Are you currently active? YesSometimesNo

Do you currently strength train?
YesSometimesNo

Do you currently do cardiovascular training? YesSometimesNo

If you answered YES or SOMETIMES to any areas above, please explain your current workout regimen:

What are your fitness goals?

Do you have any past/ present medical concerns or injuries that limit your activity? Medications? Please explain.

Do you prefer a male or female trainer?

or a Specific Trainer?

What types of characteristics are you looking for in a personal trainer? Any specific type of training?

What day(s) of the week would you like to train? MondayTuesdayWednesdayThursdayFridaySaturdaySunday

How many times per week do you want to work with a Personal Trainer?

What time of day would you like to train? Early morningMorningAfternoonEvening

How many sessions are you looking to purchase? See rate sheet

Group Training with: (list up to 3 others)

Late Policy:

Arriving late to your session results in loss of session time.

Cancellation Policy:

24-hour notice is required to cancel or reschedule a session.
A no-show will be considered a paid session.
To cancel a session, please call the trainer directly.
All personal training sessions must be used within three months of the package purchase date.

By checking this box and typing my name below, I am acknowledging that I have read and understand the late policy and cancellation policy.

First name*

Last name*

Hampshire Regional YMCA