Ann Arbor YMCA - Personal Training Intake

Please allow up to 48 hours for your personal trainer to reach out to you and provide our package pricing for training sessions.

What is today's date?

mm/dd/yyyy

First and Last Name

(If client is a minor, list client's name then guardian's name.)

What is your YMCA member status?

What is your email address?

(Parent or guardian's contact information must be included if client is under 18 years of age.)

What is your phone number?

(Parent or guardian's contact information must be included if client is under 18 years of age.)

What is the best way to reach you?

(Select all that apply.)

Age

Gender identity and/or pronouns

What kind of personal training are you interested in?

(If you would like partner or group training, please have each individual fill out an intake form separately.)

Do you have a specific trainer in mind? (This does not guarantee you will be matched with them, subject to both party availability)

(Select all that apply.)

When are you available for personal training? From your total availability, what are your preferred times?

(Your flexibility when possible is appreciated.)

How would you describe your current level of fitness?

Please describe your current workout routine and/or level of physical activity.

What are your current fitness goals?

Have you ever worked with a trainer before?

(If yes, when was it? Please give a short description of your experience.)

Describe why you'd like to work with a trainer and what your expectations are for personal training.

Do you have any injuries or conditions that may interfere with exercise? If so, please describe.

Is there anything else you'd like us to know?

PAR-Q

Physical Activity Readiness Questionnaire The health benefits of regular physical activity are clear. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary to seek further advice or clearance from your doctor prior to working with a personal trainer at the Y. *If you answer YES to ANY of the below PAR-Q questions, you must obtain medical clearance before participating in personal training.*

Has your doctor ever said that you have a heart condition or untreated or uncontrolled high blood pressure?

Do you feel pain in your chest at rest, during your daily activities, or when you do physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure) that might impact your ability to engage in physical activity?

Do you currently have a bone, joint, or soft tissue issue that could be made worse by engaging in physical activity?

Has your doctor ever said you should only do medically supervised physical activity?

Please click the box here if you answered NO to ALL the above PAR-Q questions.

Please click here if you answered YES to ANY of the above PAR-Q questions.

Informed Consent for Exercise Participation

I have enrolled in the personalized health and fitness program offered through the Ann Arbor YMCA. I recognize the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation in purely voluntary and in no way mandated by the Ann Arbor YMCA. In consideration of my participation in this program, I hereby release the Ann Arbor YMCA and its agents from any claims, demands, and causes of action as a result of my voluntary participation and enrollment. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls or tears, broken bones, joint or back injuries, or any other illness or soreness that I may incur, including death. I understand that I am responsible for monitoring my own condition throughout the exercise program and should any unusual symptoms occur, I will cease my participation and inform the instructor of the symptoms. In the event that a medical clearance must be obtained prior to my participation in the exercise program, I agree to consult my physician and obtain written permission from my physician prior to the commencement of any exercise program.

By entering my initials in the box below, I affirm that I have read the above Informed Consent to Exercise Participation in its entirety, that I understand the nature of an exercise program, and agree to the terms.

(For guardians completing form for a minor: list your initials affirming your consent for the minor client's participation.)

Personal Training Cancellation, Late, and Purchase Policies

Your appointment is valuable; it is reserved for you, and you alone. Therefore, we ask that you provide at least 24 hours’ notice for a cancellation. Members who provide less than a 24-hour notice will be charged for their session. To cancel an appointment, please contact your trainer directly or reach out to Jen Baca, Director of Healthy Living, at jbaca@annarborymca.org or 734-661-8043. Trainers will wait up to 15 minutes for a late client. However, even if a session begins late, it will end at the scheduled time, and no discount will be offered. If you are participating in buddy or small group personal training, please note that you will not be able to make up sessions individually. If you miss the session, but the other people in your group do not, you will still be charged for the session. You may purchase personal training sessions in-person by stopping by the Membership desk, by calling Membership desk at 734-996-9622, or by contacting Jen Baca at jbaca@annarborymca.org. Scholarship is not available for personal training. If you're interested in a payment plan, reach out to Jen directly at jbaca@annarborymca.org. **All personal training sessions must be purchased and paid for prior to the delivery of those sessions.**

By entering my initials in the box below, I affirm that I have read, understand, and agree to the above Cancellation, Late, and Purchase Policies for personal training at at the Ann Arbor YMCA.

(For guardians completing form for a minor: list your initials affirming you agree to the above policies.)

Send me a copy of my responses

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