WSU: Personal Training Intake Form

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Personal trainers are available for students, faculty, staff, alumni and the community who are members or non-members of the DeFeudis Fitness Center. Our goal is to educate and empower students and members/non-members on how to properly use and incorporate important aspects of fitness, Wellness, and conditioning in their life, while attaining realistic set goals.

Personal Training sessions are available in either 30 minute or 60 minute packages. Full pricing details can be found at https://www.wsulancers.com/Wellness/Personal_Training.

All information collected is kept confidential between the DeFeudis Fitness Center Manager, the appointed Personal Trainer, and the client. If you have additional questions please contact Dean Bowen at dbowen2@worcester.edu or 508-929-8291.

The first section provides us with your basic information.

Email *

First & Last Name *

Cell Phone Number *

Preferred Email Address *

Emergency Contact (Name & Phone Number) *

Worcester State University Affiliation *

Gender Identity *

Male

Female

Non-Binary

Prefer not to answer

Other:

Current Age *

Current Height *

Current Weight *

Current Occupation *

Do you prefer a Male or Female Personal Trainer? *

Male

Female

No Preference

Are you requesting a specific Personal Trainer, if so please list.

Please indicate your availability for Personal Training sessions, weekdays and weekends (based on facility hours: https://wsulancers.com/Wellness/fitness_-_wellness/Fitness_Center_Hours) *

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