Please include times with AM/PM

Do you take medicine for the following health conditions?

Please use the space below to record three specific commitments that you are willing to make to your own health and fitness goals. For example, you might commit to “arrive ready for exercise on Mondays, Wednesdays and Fridays by 6:30 pm.” Your commitments should be challenging, but also realistic and attainable. When finished, please sign this form to signify your personal commitment.

• To begin this process, please purchase your Personal Training sessions/package at Membership Services • Please give this Request Form and the Questionnaire to the Membership Service staff member when completed. • A Personal Trainer will be assigned to you based on your request form information and the availability of the trainer. You will be contacted within 48-72 hours to establish your first appointment and consultation. • Please note: the first session of a personal training package will be a consultation and short workout. • Policies: Length of Sessions: In order to answer questions and confirm next appointment, 1 hour sessions will include 55 minutes of exercise programming and ½ hour sessions will include 25 minutes of exercise programming. Personal Training Cancellation Policy: to cancel an appointment, contact the Personal Trainer directly, at least 4 hours in advance. Failure to do so will result in forfeiting the session. Duet, Trio and Group Training Cancellation Policy: In the event that one partner(s) is not able to make a scheduled appointment, there are two options available: (1) reschedule the entire group for an alternate day/time OR (2) keep the regularly scheduled appointment and all partner(s) will be billed for the appointment regardless of attendance. Late Policy: Personal Trainers will still honor the appointment in the event a client is late; however, sessions that begin late will end at the originally scheduled time. Expiration Policy: All personal training sessions/package expire one year from date of purchase. Refund Policy: All sessions/packages are non-refundable. If dissatisfied with a trainer or trainer’s service, a client may request a replacement personal trainer through Ellen Papan, Assistant Director of Fitness & Wellness Services.