Thank you for taking the first step toward working with one of our certified personal trainers. Whether you are new to fitness or have years of experience, our trainers bring the expertise, knowledge, and enthusiasm to guide you toward your fitness and wellness goals. Please complete this form so we can match you with the trainer best suited to your needs. Once your form is submitted, a member of our professional staff will contact you to schedule your initial consultation.

Enjoy the benefits of working with a certified personal trainer!

First Name *

Last Name *

Pronouns (ie: she/he/they) *

Email *

Phone # *

GVSU Affiliation *
Faculty
Staff
Student
Community Member

What are your fitness and wellness goals? *

If you have a trainer preference, please indicate.

Which package are you interested in? *
- Select Option 3 Sessions 5 Sessions 10 Sessions 15 Sessions 20 Sessions I'm not sure

Desired number of training sessions per week? *
- Select Option 1 2 3 I'm not sure Not listed

Please indicate all of the times you are AVAILABLE to meet with a trainer on the following days.  Please keep in mind that each training session is 60-minutes.

Examples:

Tuesdays: 5:00 p.m. - 9:00 p.m.         Wednesdays:  12:00 p.m. - 4:00 p.m.         Fridays:  8:00 a.m. - 12:00 p.m.

Monday *

Tuesday *

Wednesday *

Thursday *

Friday *

Saturday *

Sunday *

Have you performed planned, structured physical activity for at least 30 minutes at moderate intensity on at least 3 days per week for at least the last 3 months? *
Yes
No

Please carefully read and select any of the following medical statements that may apply to you. If none apply, please confirm this with the bottom selection. *
Do you experience chest pain at rest or with exertion?
Do you experience symptoms of dizziness, fainting, or blackouts?
Do you experience symptoms of forceful, rapid, or irregular heart rate?
Do you have a chronic cardiovascular, metabolic, or renal condition?
Do you have high blood pressure and/or a heart condition?
Other reason that is not listed above.
I confirm that none of the statements above apply.

If you selected "Other reason", please briefly describe below: *

Record Request

In order to comply with all patient confidentiality guidelines, we are requesting that you complete this release form, which will allow us to communicate with your physician, therapist, coach or other provider, if we have any concerns related to your medical history. If you do not currently have a physician, please list your most recent physician’s information and date of last visit.

Please download and fill out this Health Care Provider (HCP) Record Request form with your HCP prior to your intake appointment: HCP Record Request

Please note that you only need to complete the highlighted sections from the first three pages. The bottom of the third page is to be completed after the form is returned to you by your Health Care Provider. You can fax the completed form to our office at (616) 331-3960.

*You will not be able to receive your personalized training program until the Record Request has been completed and faxed back to our office. If you have any questions, please feel free to contact our office via email, [email protected], or phone at (616) 331-3659. 

Personal Training Acknowledgement of Risk and Release of Liability 

Purpose:  The purpose of your Personal Training program is to assist you in establishing/increasing/maintaining positive exercise behaviors as well as improving health-related physical fitness. Your individual exercise program will be designed based on your interests, current self-reported fitness level, and the exercise equipment you have available.

Acknowledgment of Risk and Release of Liability: I hereby declare, assert, and affirm that my participation in the Grand Valley State University Recreation and Wellness Personal Training program, is done having voluntarily and knowingly assumed all risks involved in this event. The immediate physical risk(s) associated are those correlated with normal, vigorous physical activity. These risks include, but are not limited to, bodily discomfort and fatigue, muscular soreness, pulled or strained muscles, overuse injuries/soft tissue damage, bodily injury resulting from falls, and the rare instance of abnormal changes/responses of the cardiopulmonary system to exercise. Adverse responses include abnormal blood pressure, heart arrhythmias, and the very rare instance of heart attack, stroke, or sudden death.  Before starting any fitness program, you should consult your physician or other health care professional to determine if it is right for your needs.

In consideration of acceptance of this contract allowing my participation in the above stated program and intending to be legally bound thereby, I hereby for myself, my heirs, executors, administrators, and assigns, WAIVE AND RELEASE any and all rights and claims for negligence, injuries, damages, equipment, facilities, staff training, or losses that I may incur involved in the above stated Recreation & Wellness program, specifically Grand Valley State University, its respective employees, agents, representatives, successors, and assigns for any and all activities connected with the above stated program. If I am a Grand Valley employee (faculty or staff member), I also understand that I do hereby WAIVE any and all rights or benefits under the State of Michigan Worker’s Compensation laws for any injury incurred as a result of my participation in this event.

Personal Training Policy

No-Show & Late Cancellation Policy
Clients must cancel or reschedule appointments at least 24 hours in advance. Cancellations made less than 24 hours before the scheduled session will be considered late cancellations and will result in a session charge. Failing to attend a scheduled session without prior notice will also result in a session charge.

Late Arrival
If clients are more than 15 minutes late, the session may be shortened or canceled at the trainer’s discretion and will still be charged in full. The session will end at the originally scheduled time to avoid affecting the next client’s session.

Refund Policy
A refund request must be submitted through the Recreation & Wellness Refund Request Form. It may take up to 4 weeks to process. All refunds are subject to a 25% processing fee. If the registration fee is over $50, processing fee will be a flat fee of $10. If payment was made by credit card, the refund is returned to the original credit card. If the refund request is denied, an explanation as to why it was denied will be provided. Refunds cannot be guaranteed if requested beyond 30 days from the original transaction date.

Acknowledgment of Understanding *
I have read, understand, and agree to all of the above statements

Please sign below: