Personal Training Registration Form

1
Name* This field is required.
First Name
Last Name
2
CWIDOr Colvin Member number. Put "N/A" if you don't remember.
3
Age* This field is required.
4
Email* This field is required.
example@example.com
5
Phone Number
Please enter a valid phone number.
6
OSU Affiliation* This field is required.
Currently Enrolled OSU Student
OSU Faculty/Staff Member
Community Member (Non-student)
7
Gender* This field is required.
Female
Male
Nonbinary
Other(Self Identify)
8
Desired Start Date
9
What is your current level of physical activity? What do you do to stay active?
10
What are your fitness goals? What expectations do you have for personal training?
11
Are you looking to purchase buddy sessions?
YESNO
12
Please list the names of Buddys you are purchasing sessions with:Please note all of you will purchase separately and all submit forms having the name of every group member
13
Personal Trainer Preference* This field is required.
Female
Male
No Preference
Specific Trainer
14
Name of Trainer
15
Which days/times are you available to train?Note: once you set a schedule with a trainer, it will remain the same throughout the semester
Mon.
Tues.
Wed.
Thur.
Fri
5am - 11am
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
12pm-5pm
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
6pm-10pm
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
5am - 11am
12pm-5pm
6pm-10pm
Mon.
Row 0, Column 0
Tues.
Row 0, Column 1
Wed.
Row 0, Column 2
Thur.
Row 0, Column 3
Fri
Row 0, Column 4
Mon.
Row 1, Column 0
Tues.
Row 1, Column 1
Wed.
Row 1, Column 2
Thur.
Row 1, Column 3
Fri
Row 1, Column 4
Mon.
Row 2, Column 0
Tues.
Row 2, Column 1
Wed.
Row 2, Column 2
Thur.
Row 2, Column 3
Fri
Row 2, Column 4
1 of 3
16
Section 1: General Health* This field is required.Signing below that you will read the following questions carefully and answer each one honestly: check YES or NO
Clear
17
Has your doctor ever said that you have a heart condition OR high blood pressure?* This field is required.
YESNO
18
Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?* This field is required.
YESNO
19
Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).* This field is required.
YESNO
20
Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?* This field is required.
YESNO
21
Are you currently taking prescribed medications for a chronic medical condition?* This field is required.
YESNO
22
Do you have a bone or joint problem that could be made worse by becoming more physically active? Please answer NO if you had joint problem in the past, but it does not limit your current ability to be physically active. For example, knee, ankle, shoulder, or other.* This field is required.
YESNO
23
Has your doctor ever said that you should only do medically supervised physical activity?* This field is required.
YESNO
24
Do you have Arthritis, Osteoporosis, or Back Problems? * This field is required.
YESNO
25
Do you have joint problems causing pain or recent fracture? * This field is required.
YESNO
26
Do you have Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High Blood Pressure.* This field is required.
YESNO
27
Do you have or have Cancer of any kind?* This field is required.
YESNO
28
Do you have heart disease or cardiovascular disease? This includes Coronary Artery Disease, High Blood Pressure, Heart Failure, Diagnosed Abnormality of Heart Rhythm.* This field is required.
YESNO
29
Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Diabetes, Pre-Diabetes. * This field is required.
YESNO
30
Do you have any Mental Health Problems or Learning Difficulties?* This field is required.
YESNO
31
Do you have any difficulty controlling your condition with medications or other physician-prescribed therapies?* This field is required.
YESNO
32
If asthmatic, do you currently have symptoms of chest tightness, wheezing, labored breathing, consistent cough (more than 2 days/week), or have you used your rescue medication more than twice in the last week?* This field is required.
YESNO
33
Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?* This field is required.
YESNO
34
Upon submission of this form, I affirm that all information regarding my health information is true and accurate. Further if this information changes prior to my first session that I will disclose to Department of Wellness Staff.* This field is required.
I agree to these terms
35
Participant Agreement / Terms and Conditions Upon Clicking on the submit button, I understand I am requesting a Personal Trainer at the Colvin and the following policies apply: If a client is not satisfied in regards to the trainer assigned, the option is available to switch trainers to better suit the client. All requests for a refund must be submitted in writing to the Assistant Director of Fitness. Reasons for Refund must include either: Medical, Military/ University Transfer and are by a case by basis approved only by the Assistant Director.* This field is required.
I agree to these terms
36
Any additional days you wish to train?
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: