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TRAINEE INTAKE

Today's Date

Last Name

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First Name

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Middle Name

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Birth Date

Age

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Sex

Male

Female

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Email Address

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Cell Phone No.

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Home Phone No.

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Work Phone No.

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Training Options

Personal Training (1 on 1)

Small Group Training (2-3 People)

Exclusive Group Training (4-10 people)

Training Availability (Time Frame)

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Training Availability (Days of the week)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Training Program (No. of weeks)

Weekly (recurring)

Bi-weekly (recurring)

Monthly (recurring-4 weeks)

4 Weeks

12 Weeks

24 Weeks

48 Weeks

Other (specify)

*Recurring options are for Exclusive Group Training Only

Training Program (No. of sessions/week)

1

2

3

4

5

Training Program Start Date

Favorite Physique (ideal body type)

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Favorite Athlete

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Emergency Contact (First Name)

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Emergency Contact (Last Name)

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Emergency Contact (Middle Name)

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Emergency Contact (Cell Phone No.)

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Emergency Contact (Home Phone No.)

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Emergency Contact (Relationship to Client )

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Payment Options

Weekly

Bi-weekly

Monthly (4 weeks)

Pay in full

Other (payments > Monthly; < Pay in full)

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