Personal Training Request Form

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):

Achieve and maintain a healthy weight
Add variety to exercise routine
General health and fitness
Improve cardiovascular fitness
Improve exercise technique
Improve sport specific skills
Increase flexibility
Increase motivation
Increase muscle strength

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:

	Mornings	Afternoons	Evenings
Weekdays	Mornings	Afternoons	Evenings
Weekends	Mornings	Afternoons	Evenings

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