Personal Training Intake Form

Personal Training Intake Form
Name*

First NameLast Name
Age*
Email*
example@example.com
Increase strengthIncrease cardiorespiratory enduranceImprove flexibilityLearn how to use the fitness center on my ownLearn general fitness formOther
What are your specific fitness goals?*
Tell us as much or just an idea, our fitness team will help with a focused goal for each workout
1x per week2x per week3x per weekOther
Early morning (6a-8a)Mid morning (8a-11a)Lunch hour (11a-1pm)Afternoon (1p-5p)Evening (5p-7p)
Main Fitness CenterSmaller Studio Space
Additional Comments for your trainer to know:
Physical Activity Readiness Questionnaire
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
If you're answered is "NO" to all of the questions above, you are cleared for general physical activity. If you answered "YES" to one or more questions, then you need to consult your doctor to clarify if you're able to complete physical activities without restrictions.

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.
Confirm that all information I entered in this form is accurate and true. Please sign below.*
Personal Training intake forms will be reviewed and you will be sent an email with instructions with next steps within 2 business days.

If you have questions/comments before that time, please email tmempz@umkc.edu
Should be Empty:

Personal Training Intake Form

Physical Activity Readiness Questionnaire