Personal Training Online Registration
Please note: Please fill in all fields. The form will not be accepted if required fields are not completed.
You must use either Internet Explorer 7.0 or FireFox 3.0 to complete this form. Registration Information
1) Name:
2) Date of Birth (mm-dd-yyyy):
3) Sex Male Female
4) Daytime Phone:
5) Evening Phone:
6) Address:
7) Email address:
8) Campus Affiliation: Student RWC Member
9) Academic Standing: Freshman Sophomore Junior Senior Graduate
10) Fitness Goals:
11) Training Expectations:
12) Trainer Preference: Male Female No Preference Specific Trainer
13)Availability:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
14) Select any of the following if they apply:
Your Doctor has said that you have a heart condition and should only perform activity recommended by a doctor. Your feel pain in your chest when performing physical activity. You have had chest pain in the last month when not performing physical activity. You have lost balance because of dizziness or ever lost consciousness. You have a bone or joint probem that could be made worse by a change in your physical activity. Your doctor is currently prescribing drugs for a blood pressure or heart condition. Your doctor is currently prescribing drugs for a blood pressure or heart condition. You know of any other reason why you should not perform physical activity.
15) If you checked any of the above, please explain:
16) Please list any additional medical concerns/conditions:
17) Please list any known allergies:
18) Select any conditions an immediate family member has suffered from:
Heart Attack Stroke Cardiovascular Disease High Blood Pressure High Cholesterol Diabetes Obesity Cancer Osteoporosis
19) If you checked any of the above, please explain:
20) How did you hear about Personal Training?
RWC Assumption of Risk Statement Participation in Recreation and Wellness Center programs is completely voluntary. Individuals participate at their own risk and assume responsibility for their own health and safety. The University of Central Florida and the Recreation and Wellness Center are not liable for injuries sustained during participation in a Recreation and Wellness Center sponsored activity. It is strongly recommended that all participants consult a physician and/or have a physical exam prior to participation. The University of Central Florida does not provide personal accident/health insurance. Therefore, participants are urged to secure their own insurance. You may suffer physical and/or mental injury from participating in these activities.
Upon clicking on the "Submit" button, I understand that I am requesting a Personal Trainer at the RWC. Upon submission of this form, I affirm that all information above is true and accurate and that I understand that there will be NO REFUNDS given once the PT sessions are bought.
Questions? Please contact RWC Adminstration Office at 407-823-2408 for assistance.
