Loading...

Personal Training Assessment Request

First My Name
First Name*
Last Name*
Phone*
Select Gender
First My Date of Birth*
Date of Birth
First My Signature*
Second My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Third My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Fourth My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Fifth My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Sixth My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Seventh My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Eighth My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Ninth My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Tenth My Name
First Name*
Last Name*
Select Gender
My Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Is email your preferable way of contact?
Location Preference*
Central Square
University Park
Trainer Gender Preference*
No Preference
Male
Female
What are your Goals you want to achieve with personal training here at VIM?
What days and times are you available?
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!