Personal Training Registration Form

Thank you for showing interest in our Campus Recreation Personal Training Program. The demographic information collected on this form is a means to ensure that we can accurately evaluate our program to ensure that we are marketing effectively to potential clientele. Once completed and submitted a personal trainer will be in contact with you within the week to set-up an initial meeting to discuss your package options and session schedule. At this meeting you will be asked to fill out a health history form and waiver. This initial meeting will not count as one of your sessions purchased. If you have any questions prior to filling out the Request a Trainer form, please contact Brian Baxter at bbaxtr@illinois.edu.

answer must be date like mm/dd/yyyy

  start dateclick calendar to choose a start date    date rules

 

Question 3

required3. Gender:
 
 
 

answer must be date like mm/dd/yyyy

  start dateclick calendar to choose a start date    date rules

Question 5

required5. Ethnicity:
 
 
 
 
 
 
 
 
 
Please provide street address, city, state, zip

Please provide street address, city, state, zip
 

answer must be phone number with area code like 217-333-1000

  phone number with area code rules

answer must be an email address

  email rules

 

Question 11

required11. Preferred Location To Train:
 
 

Question 13

13. PT Offering Preference: (Select personal training offerings that you are interested in purchasing)
 
 
 
 
 
 

answer must be numeric

If you are a student, are you a

16. If you are a student, are you a
 
 
 
 
 

Question 17

17. How did you hear about Campus Rec Personal Training? (Check all that apply)
 
 
 
 
 
 
 
 
 

Enter email address to receive a copy of this Form.  
 

Thank you for filling out this form to request a trainer.  Please note that at this time we have a very high influx of personal training requests.  This is typical during this time of year.  We will do our best to get you connected with a trainer as soon as we possibly can so we can help you reach your fitness goals.  We have started a waiting list and will reach out to you as soon as a trainer becomes available to take on more clients.  Sorry for the delay.