Online Personal Training Form

Online Personal Training Form

To get more information about personal training and a complimentary session, please fill out this form.
Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Days You'd Like To Train:*

TuesdayWednesdayThursdayFriday
Time you can train*

:HourMinutesAM/PM Option
Time Zone
Date you'd like your complimentary session

MonthDayYear
Date
How long would you like to train?

40-min50-min60-min
What are your short term (1-3 months) health and fitness goals?
What are your long term (3-6+ months) health and fitness goals?
What is your biggest challenge when getting fit?
Unless you've made other arrangements Personal Training is live through zoom, an online video portal. Do you have a camera on your computer?*

YesNoN/A
Physical Active Readiness Questionnaire (PARQ):
Do you smoke?*

NoYes
Do you have ANY health issues? Please be specific.
Is there any reason exercise may be harmful for you? If so, please explain
If you are male over 45 or female over 55, have you been examined by your doctor within the last 12 months and are FREE and CLEAR to exercise?*

YesNo
Is there anything else you'd like your trainer to know?
MICHELLE HAS OVER 20-YEARS EXPERIENCE. LEGAL DISCLAIMER: YOU ACKNOWLEDGE THAT INJURY MAY RESULT FROM EXERCISE ROUTINES. YOU AGREE WOMEN BEING FIT™, YOUR PERSONAL TRAINER, MICHELLE MELENDEZ SHALL NOT HAVE ANY LIABILITY OR RESPONSIBILITY FOR ANY INJURY OR HARM AS A CONSEQUENCE OF YOUR PARTICIPATING IN THIS EXERCISE PROGRAM. YOU ASSUME FULL RESPONSIBILITY AND RELEASE WOMEN BEING FIT™, YOUR PERSONAL TRAINER, MICHELLE MELENDEZ OF ANY CLAIM SHOULD YOU BE INJURED IN ANY CAPACITY.
PLEASE SIGN THAT YOU HAVE READ THE ABOVE LEGAL DISCLAIMER*
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