University of Vermont

Fitness & Wellness

Personal Training Registration Form

First Name:
Last Name:

Date of Birth (mm/dd/yyyy):

Primary Telephone:

Availability (days of the week & times):

Personal Trainer Preference (select all that apply)
Male (student)
Male (non-student)
Female (student)
Female (non-student)

Names of Trainers (If you are requesting a particular trainer)

Please list (if any) physical or medical conditions, ailments, or limitations that may restrict your ability to engage in moderate to vigorous exercise:

Why are you seeking a personal trainer?

Have you worked with a personal trainer before? If yes, what did you like or dislike about the training?

What does your current weekly fitness routine consist of? (i.e. one day of jogging for 30 minutes and gym machines to build strength two days a week for 20 minutes)

Have you registered for your package? Yes No

What package did you register for?

Problems with submission? Contact

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