Personal Training form

PAYMENT LINKS

All trainer fees should be made to each trainer you are working with.

Personal Training fee: Starts at $1500
REGISTRATION
What is your name?

First Last
What is your gender?
Date of Birth

MonthDayYear
Date
What is your email address?
example@example.com
What is your home address

Street name

Street name Line 2

CityParish

Zip Code
Phone Number

Area CodePhone Number
Job Title
"Please specify the organization you work for as well"
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
What is the name of your Trainer?

RichardoRonaldoTanyaDaveRayI have not booked one as yet
Self Assessment Information
Have you done any workout programs before?

YesNo
Please specify which workout programs have you done?
When was the last time you have participated in physical fitness programs?

1 Month Ago2 Months AgoN/AOther

How do you rate yourself in terms of fitness?

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

What are your goals?
"What do you hope to achieve by joining the gym"
Medical Information
Are there any illnesses, medical or physical condition or have you ever done surgery that may have a negative impact while exercising?(Please specify below)
Please provide the details and frequency of dosages. Enter N/A if none (Please answer truthfully as failure to provide truthful information in regards to your medical history that could be made worst by working out could result in severe injuries. Be cautious, clients workout at their own risk, Myers Fitness Centre will not be held accountable for any injuries that may be sustained while using the facility).
Disclaimer
Signature
CONTACT US @ 876-441-2032/876-622-3887, myersfitnesscentre@outlook.com.
PLEASE FORWARD ALL PAYMENTS RECEIPT TO myersfitnesscentre@outlook.com or whatsapp 876-796-3679
Should be Empty:

REGISTRATION