Personal Training Registration Form
Personal Training Registration Form
Client Information:
Client Information:
*
First
Last
Age:
Gender:
male
woman
member
non-member
Number of Sessions Wanted:
Best time to call:
Phone:
Phone:
-
###
-
###
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Email:
Personal Preferences:
My Personal Training goals are:
Days of the week that I prefer Personal Training:
Days of the week that I prefer Personal Training:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Time of the day I would like Personal Training:
Time of the day I would like Personal Training:
Morning (6-8 am)
Morning (8-11am)
Lunch (11-1pm)
Afternoon (1-3pm)
Afternoon (3-5pm)
Evening (5-7pm)
Evening (7-9pm)
I would prefer a:
I would prefer a:
male trainer
female trainer
no preference
I would like a specific trainer to train me: (optional)
Privacy Statement: (please check the box)
*
Privacy Statement: (please check the box)
I hereby agree that the Wellness Institute may disclose certain of my personal health information for the purposes of health coaching, and I understand that the Wellness Institute will handle this information in accordance with its privacy policy, and that it cannot absolutely guarantee privacy or control the access to its information contained on this webpage.
Any other information to share: