TRAINEE INTAKE
Today's Date*
Last Name*
First Name*
Middle Name
Birth Date*
Age*
Sex*
Male
Female
Mailing Address*
Email Address*
Social Media Profile Handles (FB, IG, etc)
Cell Phone No.*
Home Phone No.
Work Phone No.
Motivation*
Goals*
Limitations/Injuries*
Training Likes/Dislikes*
Training Options*
Personal Training (1 on 1)
Small Group Training (2-3 People)
Exclusive Group Training (4-10 people)
Training Availability (Time Frame)*
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)*
Favorite Athlete*
Emergency Contact (First Name)*
Emergency Contact (Last Name)*
Emergency Contact (Middle Name)
Emergency Contact (Cell Phone No.)*
Emergency Contact (Home Phone No.)*
Emergency Contact (Relationship to Client )*
Payment Options*
Weekly
Bi-weekly
Monthly (4 weeks)
Pay in full
Other (payments > Monthly; < Pay in full)
Additional Comments