Personal Training Request

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Please correct the field(s) marked in red below:

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Contact Information:

Contact Information:
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Address:

Address:
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Emergency Contact:

Emergency Contact:
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Preferred day(s) to train (Please check all that apply):

Preferred day(s) to train (Please check all that apply):
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Preferred time(s) to train:

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Special Considerations:

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Please pick a trainer preference:

Please pick a trainer preference:
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Please indicate your primary fitness goals:

Please indicate your primary fitness goals:
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What is your present level of physical activity?

What is your present level of physical activity?
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Which of the following do you have experience with (please check all that apply)?
Which of the following do you have experience with (please check all that apply)?

Please indicate below the training and number of sessions you are requesting.

Private:   one-on-one individualized training
Partner:  workout and train with a partner
Group:  training for up to 4 people (you organize your own group)

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Prices listed for partner and group trainings are total cost, not cost per person:

Prices listed for partner and group trainings are total cost, not cost per person:
Please note:
 There are no discounts on the cost of training sessions. 
 You must notify your trainer 24 hours in advance of cancellation.
 If there is not a 24 hour notice, you will be charged for the missed session.

Other Services

 Please indicate if you are interested in either of these other services offered.
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Fitness Assessment
 Using Polar TriFIT technology, a Certified Personal Trainer will evaluate your strength, flexibility, cardiovascular fitness, body composition and metabolic needs. 

Cost per session:  $55

 

Fitness Assessment Using Polar TriFIT technology, a Certified Personal Trainer will evaluate your strength, flexibility, cardiovascular fitness, body composition and metabolic needs. Cost per session: $55
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Body Composition Testing
 Using skinfold calipers, a Certified Personal Trainer will determine your body composition, or the relative percentage of body weight that is fat and lean tissue.

Cost per session: $15

Body Composition Testing Using skinfold calipers, a Certified Personal Trainer will determine your body composition, or the relative percentage of body weight that is fat and lean tissue. Cost per session: $15
Physical Activity Readiness Questionnaire

 Please take a moment to complete the modified physical activity readiness
 questionnaire below. Regular exercise is associated with many health benefits,
 yet any change in activity may increase the risk of injury. Completion of this 
 questionnaire is a first step when planning to increase the amount of physical activity in your life. Please read each question and answer it honestly.
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1.  Has a physician ever said you have a heart condition and you should only do physical activity recommended by a physician?

1. Has a physician ever said you have a heart condition and you should only do physical activity recommended by a physician?
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2.  When you do physical activity, do you feel pain in your chest?

2. When you do physical activity, do you feel pain in your chest?
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3.  When you were not doing physical activity, do you feel pain in your chest?

3. When you were not doing physical activity, do you feel pain in your chest?
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4.  Do you ever lose consciousness or do you lose balance because of dizziness?

4. Do you ever lose consciousness or do you lose balance because of dizziness?
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5.  Do you have a joint or bone problem that may be made worse by a change in your physical activity?

5. Do you have a joint or bone problem that may be made worse by a change in your physical activity?
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6.  Is a physician currently prescribing medications for your blood pressure or heart condition?

6. Is a physician currently prescribing medications for your blood pressure or heart condition?
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7.  Are you pregnant?

7. Are you pregnant?
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8.  Do you have insulin dependent diabetes?

8. Do you have insulin dependent diabetes?
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9.  Are you 69 years of age or older? 

9. Are you 69 years of age or older?
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10.  Do you know of any other reason you should not exercise or increase your physical activity?

10. Do you know of any other reason you should not exercise or increase your physical activity?
If you answered "yes" to any of the above questions, talk with your doctor BEFORE
 you become more physically active. Tell your doctor about your intent to exercise,
 and to which questions you answered "yes". If you honestly answered "no" to
 all questions, then you can be reasonably positive that is is safe to gradually increase
 your level of physical activity. If your health changes such that you then answer
 "yes" to any of the above questions, seek guidance from a physician.

Thank you for choosing to train with Ida Lee Recreation Center.

 All of our personal trainers are certified by nationally recognized organizations and
 have experience working with a wide range of clients.

To gain the most from your session(s), please observe the following: 

 1. All services are available by appointment only. 
 2. There are no discounts on the cost of any services unless authorized by the Fitness Manager. 
 3. Clients must pay for all services in advance. 
 4. Sessions are approximately one hour. 
 5. Trainer fees are subject to change.

Cancellation Policy

 To cancel a training session, YOU MUST CONTACT YOUR TRAINER DIRECTLY WITHIN 
 24 HOURS of your scheduled session. Failure to cancel within 24 hours will result 
 in you being charged for the session. Clients who arrive more than 15 minutes late 
 will be charged for the session. In addition, the trainer may cancel the session. 

Participant assumption of risk:
I understand that participation in any physical activity involves inherent risks, and that even
when safety precautions are utilized, injuries can occur. I fully agree to assume all risks
when following the fitness program and exercises prescribed by Ida Lee Recreation Center
and its trainers, and agree to hold them harmless in the event such injury occurs. If I
experience unusual pain or discomfort during participation in any activity, I will inform
the trainer immediately. I am aware that personal health/accident insurance is my responsibility.
I claim that to the best of my knowledge, I do not have any medical issue that will prohibit
my safe participation in this exercise program. 


By hitting the "submit" button below, you agree to the above training policies.

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