Personal Training Interest/Request Form
Interested in Personal Training or a 4-week program? Fill out this form and we'll contact you to set up an initial consultation to see how we can help you meet your goals or just get started!

Personal Training Cost: $45/45 minute session
4-week Programming Cost: $75 (2-3 workouts either strength or cardio)

FREE 30-Minute pre-session consultation with trainer to establish program design with any training package (re-consultation required if returning to personal training after a period of 6-months or longer).

IMPORTANT INFORMATION:
*Participants are required to submit this form with their health history and will need to fill out a PAR-Q form before their first training session.  If needed, based on response from PAR-Q test, a medical clearance from will be required prior to first training session.
*Payment for the training package is due in-full prior to the initial consultation with your personal trainer.  After receiving request, a personal trainer will contact you directly to schedule your consultation.  
*Personal training packages are non-refundable and non-transferable.  Sessions must be scheduled and used within 6-months of purchase date.
*NO PAC membership or daily use required.
*Once sessions are scheduled, a 24-hour cancellation notice is required for rescheduling sessions.  Failure to give this notice will result in a loss of that session with no reimbursement.
*All personal information shared with personal trainers is confidential.

 
Sign in to Google to save your progress. Learn more
Name *
Email Address *
Phone Number: *
Age: *
What service are you interested in?
Clear selection
If Personal Training, which days do you prefer to train? *
Required
If Personal Training, what time of day to you prefer to train? *
Required
If personal training, specific preferred training time:
Emergency Contact Name: *
Emergency Contact Phone Number: *
Emergency Contact Relation: *
Physicians Name: *
Physicians Phone Number: *
Are you taking any medications, supplements, or drugs?  If so, please list medication, dose, and reason. *
Please list any injuries, recent surgeries, limitations, or concerns for your trainer to be aware of. *
Please list any injuries, recent surgeries, limitations, or concerns for your trainer to be aware of. *
Describe any physical activity you do on a somewhat regular basis. *
Does your physician know you are participating/planning to participate in an exercise program? *
Do you now have, or have you had in the past: (check all that apply) *
Required
Briefly describe your health and fitness goals *
You will be required to fill out a hard copy of the PAR-Q before training.
Electronic Signature: By Signing below you are agreeing to our Waiver of Liability; INDEMNIFICATION AGREEMENT AND COVENANT NOT TO SUENOTICE; This is a legally binding agreement.  By signing this agreement, you give up your right to bring court action to recover compensation or obtain any other remedy for injuries to yourself or your property or for your death arising out of your use of the Pinedale Aquatic Center now or anytime in the future. Acknowledgement of risk: I, the undersigned user, hereby acknowledge and agree that the sport of rock climbing, racquetball, exercise, swimming, running, tennis, or any other activity associated with the use of the Pinedale Aquatic Center, located at 535 N. Tyler Ave. Pinedale, WY 82941 poses inherent risks. I have full knowledge of the nature and extent of all of the risks associated with the use of the Pinedale Aquatic Center.   *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pinedale Aquatic Center. Report Abuse
Google Forms