Personal Training Form

Today’s Date:

Name:

Age:

Email Address:

Best phone number to reach you:

What location would you like training? (please include entire address)

Days you’d like to train:

Mon
Tue
Wed
Thur
Fri
Sat
Sun

Time you’d like to train:

What is the date you wish to start training?

Do you smoke? If so, how much?

Do you have ANY health issues your trainer should know about? This includes but not limited to: high blood pressure, high cholesterol, heart condition, joint, muscle or other injuries. Please include ANY and ALL ailments no matter how small.

Is there any reason exercise may be harmful for you?

If you are male over 45 or female over 55, have you been examined by your doctor within the last 12 months and are FREE and CLEAR to exercise?

Yes
No

What are your top 3 goals for hiring a trainer? What do you want to see in 90-days?

What are your biggest fitness challenges?

Is there anything else you wish to tell your trainer?

PAYMENT INFO: You understand and agree that payments are taken monthly from your credit card authorized by you. You are sent an email at the end of each month with the invoice for your following month. If you know your schedule for that month and need to cancel a session, reply to the email and let us know. Your invoice will be adjusted and you’ll be sent a new email with the adjusted invoice. (You will be given a separate payment form for your credit card information.)

Yes
No

MISSED SESSION(S): If this is a group training, does your group want its members to pay for the session if they are not able to make it and give advance notice stating they’re missing a session? If you answer “No”, the other members WILL pay the remaining balance and the member missing the session will NOT pay for a session they are unable to take. The member missing a session simply replies to the invoice email they receive at the end of each month stating the date(s) they’ll be missing.

Yes
No
N/A

CANCELING A SESSION: You understand you have 24 hours to cancel a session or it is forfeit. If you cancel within 24 hours, that session will be credited to the following month and be shown on your next month’s invoice.

Yes
No

30-DAY NOTICE OF CANCELATION: You understand and agree to the standard 30-day cancelation policy and will give us a 30-day notice if and when you wish to cancel? This policy applies after your first 30-days with us. Within your first 30-days you may cancel anytime. After that we ask that you give us a 30-day notice. (This policy gives us the chance to keep our trainers income consistent as we find a replacement for your training time. Thank you for understanding and agreeing to this policy.)

Yes
No

You HAVE READ AND UNDERSTAND THE ABOVE AGREEMENT. YOU AUTHORIZE MICHELLE MELENDEZ OF THE PILATES CARDIOCAMP TO CHARGE MY CARD ACCORDING TO THE TENETS OF THE AGREEMENT ABOVE.
Rates per session: single: $115, two clients: $140. If you are signing up with a friend your card will be billed your % of the training and not the entire bill. (Please sign your name)

YOU ACKNOWLEDGE THAT INJURY MAY RESULT FROM EXERCISE ROUTINES. YOU AGREE PILATES CARDIOCAMP™, YOUR PERSONAL TRAINER AND MICHELLE MELENDEZ SHALL NOT HAVE ANY LIABILITY OR RESPONSIBILITY FOR ANY INJURY OR HARM AS A CONSEQUENCE OF YOUR PARTICIPATING IN THIS EXERCISE PROGRAM. YOU ASSUME FULL RESPONSIBILITY AND RELEASE PILATES CARDIOCAMP™, YOUR PERSONAL TRAINER AND MICHELLE MELENDEZ OF ANY CLAIM SHOULD YOU BE INJURED IN ANY CAPACITY. (Please sign your name)

Please fill out this form to get your complimentary personal training session with us!