Name:*

Phone Number (123-456-7900):*

Alternative Phone Number:

Email Address:*

Age:

Training Goals:

To increase success in achieving your goals, our personal trainers believe your goals should be "SMART"- specific, measurable, attainable, relevant  and time-bound.

Your fitness goals (check all that apply):

Other Training Goals:

Current Activity Level:

Rate your current fitness level (1=poor, 10=best)

How often do you currently participate in physical activity? (Choose one)

Availability & Preferences:

Choose which days and times you would be available:

MorningsAfternoonsEvenings
Weekdays
Weekends

Trainer Preference:*

Preferred Training Location:*

Personal information is collected for the purpose of responding to your request. The City of Surrey is collecting this information under s.26(c) of the Freedom of Information and Protection of Privacy Act. For questions regarding the collection of personal information please contact the Manager of Marketing and Communications, 13450 104 Avenue, Surrey, BC V3T 1V8  |  604.591.4011