Personal Training Registration

Thank you so much for your interest in personal training with Campus Recreation. We look forward to working with you to achieve your fitness and wellness-related goals. Please fill out this form with as much detail as possible to ensure a timely match with one of our certified trainers. If you have any questions or concerns regarding your registration, please email Traci Smith (traci.smith@uc.edu). Once your registration is received, you will be contacted within 2-3 business days with further instructions on getting started!
MEMBER STATUS
Please check your affiliation with Campus Recreation.*

StudentFaculty/StaffMemberNon-Member
SERVICES

Choose the personal training type and package that you plan to purchase.

Note: A fitness assessment will count as the first session in a package
Training type*

IndividualBuddySmall Group Training
Individual Sessions
Select # of sessions
Buddy Sessions
Select # of sessions; groups of 2; price listed on website is cost per person
Name of Training Partner (Buddy)
Small Group Training Sessions
Select # of sessions; groups of 3-6; price listed on website is cost per person
Name of Training Partner(s)
REFERRAL PROGRAM

If you were referred by an active* training client, please tell us who. You and your friend will each receive 1 FREE training session with your initial** purchase of session packages of 5 or more.

*Active clients have an open training package with sessions remaining
** An initial training purchase is the first training purchase within the last year
Yes! I was referred by:
Active* training client name

CONTACT INFORMATION
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Age*
Gender with Which You Identify*
Primary Phone Number*

Area CodePhone Number
Email*
Trainers reach out initially via email
Emergency Contact*
Emergency Contact Phone *

Area CodePhone Number
Physician*
Physician Phone Number*

Area CodePhone Number

If you answered YES to one or more of the follow-up questions about your medical condition, you should seek further information before becoming more physically active or engaging in a fitness appraisal. Prior to beginning the personal training program, you will be asked to get a medical release.

Participant Declaration

All persons who have completed the PAR-Q+ please read and sign the declaration below. If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian or care provider must also sign this form.
I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that a Trustee (such as my employer, community/fitness center, health care provider, or other designate) may retain a copy of this form for their records. In these instances, the Trustee will be required to adhere to local, national, and international guidelines regarding the storage of personal health information ensuring that the Trustee maintains the privacy of the information and does not misuse or wrongfully disclose such information.
Name (Entering name below constitutes signature)*

First NameMiddle NameLast Name
Date

MonthDayYear
Name of legal guardian if above signed is under 18

First NameMiddle NameLast Name
Date

MonthDayYear

FITNESS SERVICES POLICIES
I have enrolled to participate in University of Cincinnati Campus Recreation Services and/or Programs.*

Please check to agree

Please type initials in the box at the right to indicate you understand each statement. I fully understand that:*

	Enter Initials
The forms listed below must be completed in full and signed prior to beginning sessions. It is my responsibility to notify my CRC staff member of any change in my health status. - CRC Release of Liability and Consent - Health History Questionnaire - Medical Consultation (if applicable)
Once a CRC staff member is identified for my needs, I am responsible for scheduling my session(s).
I should be dressed and ready to begin at the scheduled start time. Session will end at the scheduled end time regardless of start time.
If I am unable to make the scheduled session due to illness, emergency, travel or any other circumstance, it is my responsibility to notify my CRC staff member 24 hours in advance and reschedule my appointment.
I will be charged in full for a session if less than 24-hour notification is given.
Payment can be made by credit/debit card, Bearcat Card or check made payable to the University of Cincinnati.
Payment must be made prior to scheduled session.
Payment is non-refundable.
Sessions expire six (6) months from the purchase date and are non-transferable.
(Buddy and Small Group Training) If either party is unable to make the scheduled session due to illness, emergency, travel or any other circumstance it is our responsibility to notify our personal trainer 24 hours in advance and reschedule the appointment. Or, the session may still be delivered to one person at the group rate; however, clients absent from this session will forfeit the session.
I will notify my CRC staff member of any medications or health conditions that may affect my ability to perform physical activity or worsen by becoming physically active.

I have read the above and agree to abide by University of Cincinnati Campus Recreation policies and procedures presented in this contract.*

Please check to agree
Name (Entering name below constitutes signature)*

First NameMiddle NameLast Name
Date

MonthDayYear
Name of legal guardian if above signed is under 18

First NameMiddle NameLast Name
Date

MonthDayYear
Campus Recreation Staff Signature

First NameMiddle NameLast Name
Date

MonthDayYear

RELEASE OF LIABILITY

University of Cincinnati Campus Recreation Center
RELEASE OF LIABILITY AND CONSENT — Wellness Services
- In consideration of the opportunity to receive and participate in University of Cincinnati Campus Recreation (“CRC’s”) Fitness/Wellness programs, I hereby assume all risks of injury, illness, death or other loss arising from or in any way relating to my participation in such programs and receipt of related services.
- I hereby release, agree not to sue, and forever discharge University of Cincinnati and CRC and their respective Affiliates* (as defined below) of and from any and all manner of claims, demands, actions, causes of action, liability, damages, claims for punitive or liquidated damages, claims for attorney’s fees, costs and disbursements, individual or class action claims, and demands of any kind whatsoever, I have or might have against them or any of them, whether known or unknown, in law or equity, contract or tort, arising out of or in any way relating to my participation in CRC programs, use of Campus Recreation and loss of personal property, however originating or existing. This release shall be binding upon my heirs, personal representatives, administrators, executors, and assigns.
- I understand that this release includes, without limitation, all injuries which may occur as a result of the following: (a) my use of CRC’s amenities and equipment in CRC facilities, my receipt of instruction and other services from CRC (including, without limitation, massage therapy services) or my participation in any activity, class, program, training or instruction; (b) the malfunctioning of any equipment; (c) CRC’s training, supervision, or dietary recommendations; and (d) my slipping and/or falling while in or on CRC’s premises, including adjacent sidewalks and parking areas.
- I further understand that any recommendations regarding exercise or diet (including, without limitation, the use of supplements) are entirely my responsibility and that I should consult a physician prior to undergoing any changes in exercise or diet.
- I understand that training programs (including related fitness assessments) and massage therapy sessions are not intended to replace any medical screening I may need, and the CRC, nor any of their respective Affiliates, will determine whether an exercise program or dietary change are medically appropriate for me. I understand it is my responsibility to consult with my physician regarding these matters.
- I further understand CRC staff will question me about my health status, and I agree to complete a health history questionnaire. I certify the information I provide to CRC staff about my health and exercise history and current health status will be, to the best of my knowledge, complete and accurate, and I agree and understand it is my responsibility to inform CRC staff in the event of any change in my health or medical status. CRC shall treat information regarding my personal health and medical status as confidential. CRC shall not release such information without my written consent, except: to authorized CRC and employees, agents, successors, and assigned contractors who we use to support our business; in connection with any programs sponsored by my employer in which I participate; in connection with the sale, assignment, or other transfer of the business which the information relates; when applicable by laws, court orders or government regulations require us to do so; and to health care personnel for treatment purposes (including, for example, emergency assistance personnel). I understand that CRC may use or disclose to others information regarding my health for statistical analysis or other research purposes, provided that my name and other personally identifiable information will be removed from the information prior to such uses and disclosures.
- I fully understand that I have enrolled in a program that may include strenuous physical activity including but not limited to muscular flexibility enhancement, aerobic exercise, and resistance training through the use of various facilities and exercise equipment. I understand there are possibilities of injury or other complications, including but not limited to musculoskeletal injuries, cardiovascular trauma, neurological impairment, heart attack and even death, which may occur during fitness assessment, while completing an exercise program, while otherwise using CENTER facilities, or while participating in any health and fitness program activities.
- I understand it is my responsibility to consult with my physician regarding my training program participation and realize it is generally recommended that all adults consult with a physician before starting a physical activity program. I understand that my CRC staff member may, based on a review of my application and health history form, require that I consult with and obtain recommendations from a physician before participating in the first session. I understand I may obtain from my CRC staff member a “Medical Consultation” form on which my physician’s recommendations can be documented and will be submitted to my CRC staff member before my first session. I acknowledge and agree that if I do not accurately and completely communicate my physician’s recommendations to my personal trainer, I take full and entire responsibility for that decision and for any outcomes related to that decision.
- I understand use of the CRC and participation in a fitness assessment, health and fitness program activities is strictly voluntary, is not required of employees of participating companies, and I may discontinue my participation at any time. I further understand CRC may revoke my privileges to use CRC or otherwise participate in assessment or other programs at any time, in its sole discretion. I agree to be bound by and obey all the rules and policies of the CRC and CRC staff in my use of the CRC and in my participation in the health and fitness program activities.
- I understand at any time I may review this Release of Liability and Consent by requesting a copy from CRC staff. I agree if any portion of this form is held invalid, the remainder of this form will continue in full legal force and effect.
- I have carefully read this Release of Liability and Consent and fully understand its terms. I sign it voluntarily with full knowledge of its legal significance and understand that I have the right to have my attorney review it.
*“Affiliates” means any branch, division, or subsidiary of CRC, or CRC’s present and former officers, directors, shareholders, trustees, employees, agents, representatives, contractors, and the successors and assigns of each, whether in their individual or official capacities.
Name (Entering name below constitutes signature)*

First NameMiddle NameLast Name
Date

MonthDayYear
Name of legal guardian if above signed is under 18

First NameMiddle NameLast Name
Date

MonthDayYear
Should be Empty:

	Sun.	Mon.	Tues.	Wed.	Thurs.	Fri.	Sat.
Early Morning 6 - 9 a.m.
Mid-Morning 9 a.m. - Noon
Afternoon Noon - 2 p.m.
Late Afternoon 2 - 5 p.m.
Evening 5 - 9 p.m.

Participant Declaration