YMCA Personal Trainer Request Form

Name:
Email Address:
Phone Number:
What is the best time of day to contact you regarding personal training?
Are you a current YMCA member?	Yes No
At which YMCA location(s) would you like to receive Personal Training services?	Downtown (Downtown Milwaukee) Rite-Hite Family (Brown Deer) Tri-County (Menomonee Falls) Feith Family Ozaukee (Port Washington) West Suburban (Wauwatosa) Southwest (Greenfield) South Shore (Cudahy) Northside (Central Milwaukee)
What are your fitness/wellness goals?	General Fitness Weight Loss/Management Strength Training Sport-specific Training Pre/Post Natal Conditioning Muscle Toning Cardiovascular Conditioning Injury Rehabilitation
Please list any health risks/conditions that your Personal Trainer should be aware of? (i.e. asthma, pregnancy, joint condition, heart condition, high blood pressure, etc.)
What other benefits are you seeking from personal training?	Workout regularity Fitness/Wellness Education Measureable Improvements Variety in workout Motivation/Support Introduction to New Exercises
Do you have a Personal Trainer preference?	Male Female No Preference
What days of the week are you available to train?	Mon Tues Wed Thurs Fri Sat Sun
What time of day would you like to train?
How many times a week would you like to train?
Is there anything else you'd like to add about your Personal Training goals?