Iowa State Personal Training Services Request Form

Iowa State Personal Training Services Request Form

*Access to facilities and trainer assignments will be limited during the holiday break. Regular operations will resume on January 21st. Questions contact recservices@iastate.edu*

Name as listed on ISU ID or Rec pass*

University ID Number*

Email:*

Please clarify other:*

Motivation for hiring a trainer:*

Current exercise level/experience*

Advanced (exercise at least 4 days per week and have specific exercise knowledge and skill)

Intermediate (exercise ~2-3 days per week, have low knowledge & skill regarding a variety of exercises and equipment for ~6 months to 1 year)

Beginner (exercise less than 2 days per week, no knowledge and skill with exercise equipment)

Please check any health issues you have experienced in the last six months or is a chronic health condition.*

Chronic issues (joint problem, back, knee, shoulder)

Musculoskeletal conditions (including injuries or recent surgeries, within last six months)

Negative experience when exercising including getting dizzy, fast heart beat, unusual breathing and muscle pain

Medical health condition diagnosed and taking regular medication to manage effectively

Have currently any of the following: heart disease, diabetes, asthma and thyroid condition

Pregnant or post pregnancy within last 12 months

Smoker or quit within the last six months

Have a disabilty requiring specific fitness training knowlegdge and exercise selection to best support me

No health issue beyond flu or allergies requiring medical treatment in the last six months

What is your preference for a trainer?*

Male

Female

No Preference

Please choose a time block for Monday-Friday sessions:*

*Note our gym is open 6am-12am Mon-Thurs, and 6am-10pm Fri

Please choose a time block for Saturday sessions:*

*Note our gym is open 8am-6pm on Saturdays

Morning 8:00am-11:00am

Midday 11:00am-4:00pm

Evening 4:00pm-6:00pm

Please choose a time block for Sunday sessions:*

*Note our gym is open 8am-12am on Sundays

Morning 8:00am-11:00am

Midday 11:00am-4:00pm

Evening 4:00pm -8:00pm

Late Evening 8:00pm-close

How many times a week do you want to work with a trainer?*

1-2 times weekly

3-4 times weekly

Once a month- Check-in and update

Member Type*

Select

Student Payment Options*

Select

Faculty/Staff/Alumni/Affiliate Payment Options*

Select

U-Bill Information

By selecting U-Bill I authorize Iowa State University to apply a one time charge to my U-Bill for the cost of the PT package I choose in order to onboard with Personal Training with Recreation Services.

I understand that by submitting this form I am responsible for all charges that are accrued as a result of violations of this agreement, and such charges will be billed directly to my University Bill (U-Bill) presented on AccessPlus. ISU may also impose a late payment charge computed at a periodic monthly rate of 1% per month on the balance or an annual percentage rate of 12% when computed from the billing date. The unpaid account may be referred for collection, and customer shall pay all collection costs and reasonable attorney’s fees if ISU must take action to recover any past due amounts. Unpaid charges may prevent you from registering for classes for the following semester or from obtaining your diploma/transcripts until paid in full.

Package Options*

Select or enter value

Terms and Conditions and Informed Consent*

Thank you for submitting the form to request our personal training services. We will get back to you shortly with information on personal trainer assignment.

If you do not hear back within 8 days please email Nora Hudson at nhudson@iastate.edu

Thank you!

Trainer Name- for U-Bill renewing clients

Personal Training

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