Personal Training Request Form

Personal Training Request

I hereby certify that I have read, understand, and accept the policies of the Personal Training Program.

I certify that I have a current Dodge Fitness Center membership.

Personal training is only available to current DFC members.

Name

First

Last

Phone Number

Age and DOB

Gender

Columbia Affiliation

Preferred Trainer

What is your availability for training?

How many times per week would you like to work with a trainer?

Type of training you are requesting

Length of session

Partner or Group Member Names (if applicable)

Your fitness goals and objectives

Your previous fitness experience

If you have worked with a trainer previously, please describe your experience.

Describe your current physical activity or exercise habits.

List any favorite physical activities or exercises.

I agree to the terms of service.

Information Confidentiality

The Columbia University Personal Training Program classes provide vigorous recreational exercise; prior exercise is presumed. If you are new to exercise or have any doubts as to your readiness to participate in an activity, you should consult your physician, the Program Director and/or your trainer. Like any activity, exercise has its risks. While trainers are intent upon preventing and minimizing the chances of these problems occurring, primary responsibility for your safe participation remains with you. Once in a session, if you experience pain, discomfort, or anxiety, stop exercising and consult with your trainer or Program Director. Any questions which may have occurred to me have been answered to my satisfaction. I understand that all information collected regarding my participation in this program will be held in strict confidence by the Physical Education staff.