Youth Personal Training Interest

Interested in Youth Personal Training
Parent's Full Name*

First NameLast Name
Parent's E-mail*
Parent's Phone Number*

Area CodePhone Number
Child's Full Name*

First NameLast Name
Child's Age
Trainer Preference*

MaleFemaleNo preference
What days work best to train?*

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundays
And times?*

Early mornings (before 8:00 am)Mornings (8:00 am - 12:00 pm)Afternoons (12:00 pm - 4:00 pm)Evenings (4:00 pm - 7:00 pm)Late evenings (after 7:00 pm)
Please indicate your personal health & fitness goals (check all that apply).*

Lose weightFeel better/more energyCardiovascular fitnessImprove flexibilityImprove balance/stabilityInjury rehabImprove muscle tone/strengthImprove athletic performanceReduce stressLearn how to use specific equipmentCreate a program to use at homeGeneral fitness
Does he or she have any physical or medical concerns that need to be addressed or that the trainer should be aware of?

YesNoI'm not sure
Please explain
Additional comments, questions, or goals
Should be Empty:

Interested in Youth Personal Training