Personal Training Form

Personal Training

Contact information and goal setting

Full Name: * Required
Date of Birth
MM slash DD slash YYYY
Personal Pronoun: * Required
Student ID:

Leave blank if you are not a Brock student
Email: * Required
Type of Training
*If registering for 2 person, personal training- List the name of the other person training with you * Required
Fitness Level: * Required
Current Physical Activity * Required
Do you have any current barriers to physical activity? Please explain: * Required
What type of of fitness activities and training do you enjoy?
What types of activities/training do you not enjoy and want to avoid?
What are your fitness goals? * Required
When are you available to workout? * Required
Please list the days and time range
Do you have a preferred trainer?
List any existing medical conditions * Required
If none, please type 'none'
List current medications
List current and past injuries and surgeries: * Required
If none, please type 'none'
List allergies and medications for them * Required
If none, please type 'none'
Consent * Required
I honestly disclosed all pertinent information
This form will be used to collect contact information and goal setting from you. Please complete it to the best of your ability. If you have any questions please email agregory@brocku.ca
Cancellations * Required
I understand that I am required to give 12 hours notice to cancel/reschedule a session
If 12 hours notice is not given, this session will not be rescheduled.
Personal Training rates
2 Person, Personal Training rates
Fees listed is per person
Training cannot begin until the PAR-Q has been completed and reviewed by a personal trainer. Please complete the following form http://eparmedx.com/wp-content/uploads/2022/01/ParQ-Plus-Jan-2022-Fillable.pdf
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Welcome to Brock University

Information for

Academics

Research

About

Quick links

Want to go to Brock but not sure where to start? We can help.

How to apply

Our programs

Our campus

More information

Recreation

In this section

Personal Training Form

Personal Training

Quick Links

Recreation News

Helpful links

Connect

Personal Training Form

Personal Training

Quick Links

Recreation News

Connect with us