Personal Training Request Please read our Personal Training Policies here prior to requesting sessions. Personal Training Request Step 1 of 3 - General Information 33% Name* First Last Email* Phone*GenderAge Date Format: MM slash DD slash YYYY Membership Type*StudentUREC MemberWhat is your preferred method of contact?*Phone CallTextEmailWould you like to work with a male or female trainer?MaleFemaleDoesn't matterWhat do you hope to achieve by participating in Personal Training?*What is your current level of activity?*InactiveSomewhat ActiveVery ActiveHow often would you like to work with a trainer?*1x per week2X per week3X per weekWhat is your availability to work with a trainer?*Please list day(s) and time(s).Please check the services you would like:*A Personal Fitness Profile (PFP) is required for all new clients purchasing Personal Training Sessions. Personal Fitness Profile (PFP) ONLYPFP + 1 1-hour sessionPFP + 5 1-hour sessionsPFP + 10 1-hour sessionsPFP + 5 30-minute sessionsPFP + 10 30-minute sessionsPFP + 5 PARTNER SessionsPFP + 10 PARTNER SessionsIf you are signing up for Partner Training, both partners must submit a request form. Please list the partner's name here.*How did you hear about Personal Training?UREC WebsiteSocial Media PostPoster or FlyerFrom a Friend Exercise Pre-participation Health Screening QuestionnaireSTEP 1 - SYMPTOMS: Do you experience any of the following? Check all that apply:* chest discomfort with exertion unreasonable breathlessness dizziness, fainting, blackouts ankle swelling unpleasant awareness of a forceful, rapid or irregular heart rate burning or cramping sensations in your lower legs when walking short distance I do not experience any of the above symptoms. If you DID mark any of the symptoms above, STOP, you should seek medical clearance before engaging in or resuming exercise. If you DID NOT mark any symptoms above, continue to steps 2 and 3.STEP 2 - CURRENT ACTIVITY: Do you currently perform planned, structured physical activity at least 30 minutes at a moderate intensity on at least 3 days per week for at least the last 3 months?*YesNoSTEP 3 - MEDICAL CONDITIONS: Have you had or do you currently have any of the following? Check all that apply.* a heart attack heart surgery, cardiac catheterization, or coronary angioplasty pacemaker/implantable cardiac defibrillator/rhythm disturbance heart valve disease heart failure heart transplantation congenital heart disease diabetes renal disease I do not or have not had any of the above medical conditions. Evaluating Steps 2 and 3: • If you did not mark any of the statements in Step 3, medical clearance is not necessary. • If you marked Step 2 “yes” and marked any of the statements in Step 3, you may continue to exercise at light to moderate intensity without medical clearance. Medical clearance is recommended before engaging in vigorous exercise. • If you marked Step 2 “no” and marked any of the statements in Step 3, medical clearance is recommended. You may need to use a facility with a medically qualified staff. Personal Training Program Policies*All first time clients must go through a Personal Fitness Profile (Fitness Assessment) prior to any Personal Fitness Training Sessions. All sessions must be prepaid and will be due prior to the appointment. Payment must be made at the University Recreation Information Center. Clients must call their trainer directly at least 24 hours in advance of the scheduled appointment to cancel or reschedule. If no contact is made within 24 hours, the client will be charged for the session. All Sessions are non-transferable and non-refundable. Our entire Personal Training policy can be found here: https://uwm.edu/urec/personal-training-policies/ I have read and agree to the Personal Training Program policies.