Personal Training Sign-Up

First Name *

Last Name *

Email *

Phone Number *

Gender

Date of Birth *

Age *

Height (in cm) *

Weight (in kg) *

What do you do for a living? *

Do you follow a regular working schedule? *

Yes No

Time of work shift? *

Please list the physical activities that you participate in outside of the gym and outside of work. *

Known injuries and health problems? Please list them. *

Your current diet could be best characterized as?

What following goals does best fit in with your goals? Choose as many if applicable.

Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss

TImeline for achieving your goal?

Have you trained with a personal trainer before? *

Yes No

If yes, what kind of training did you do? *