Youth Personal Training Interest

Interested in Youth Personal Training
Parent's Full Name *

First Name Last Name
Parent's E-mail *
Parent's Phone Number *

Area Code Phone Number
Child's Full Name *

First Name Last Name
Child's Age
Trainer Preference *

Male Female No preference
What days work best to train? *

Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Sundays
And times? *

Early mornings (before 8:00 am) Mornings (8:00 am - 12:00 pm) Afternoons (12:00 pm - 4:00 pm) Evenings (4:00 pm - 7:00 pm) Late evenings (after 7:00 pm)
Please indicate your personal health & fitness goals (check all that apply). *

Lose weight Feel better/more energy Cardiovascular fitness Improve flexibility Improve balance/stability Injury rehab Improve muscle tone/strength Improve athletic performance Reduce stress Learn how to use specific equipment Create a program to use at home General fitness
Does he or she have any physical or medical concerns that need to be addressed or that the trainer should be aware of?

Yes No I'm not sure
Please explain
Additional comments, questions, or goals
Should be Empty:

Interested in Youth Personal Training