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Home
Personal Training
Small Group Personal Training
1-on-1 Personal Training
Gym Membership
Resources
Calculators
Blog
Contact-Us
Remote Training Application
PT (1/2) - Application
Name
*
First
Last
Email
*
Phone
*
Date of Birth:
*
MM
DD
YYYY
Sex
*
Male
Female
What is your goal with personal training?
*
Lose weight
Increase muscle
Improve strength
Improve flexibility and mobility
Fitness education
Improve balance and coordination
Learn about nutrition
Post rehab training / recover from an injury
Increase speed and power
Sports specific training
Learn exercise form and technique
What is your current weight?
*
Please write in your current weight in pounds
What is your goal weight?
*
Please write in your goal weight in pounds
Hidden
Hidden (Weight Loss Goal - Pounds Wanting to Drop)
*
Hidden
Hidden (Weight Gain Goal - Pounds of Muscle Wanting to Gain)
*
What sport(s) are you participating in?
*
Do you have a competition or event coming up you're training for? If so, when?
*
(optional) Please describe your goal in further detail.
Tell us about the goal(s) you most want to achieve.
On a scale of 1-5, how serious are you about reaching your goal(s)?
*
1
2
3
4
5
1 is "not serious at all", 5 is, "it is currently my primary focus in life".
Tell us about the struggles and roadblocks you face in reaching your goal(s).
*
How often would you like to work with a trainer?
*
Just a few sessions
1x/week
2x/week
3x/week
4x/week
5x/week
When is the best time for you to set up personal training?
Weekday mornings
Weekday afternoons
Weekday evenings
Weekend mornings
Weekend afternoons
Weekend evenings
We'll figure out more exact times later.
Do you currently belong to another gym?
*
Yes
No
Program Variables
Resistance Training Program Variables
Please rate your level when it comes to resistance training and free weights.
*
Beginner
Intermediate
Advanced
Have you ever participated in a structured, professionally designed resistance training program?
*
Yes
No
Are you currently participating in this resistance training program?
*
Yes
No
How long have you been following this plan?
*
Less than 6 months
6 months to 2 years
2+ years
When was the last time you participated in a structured resistance training plan?
*
less than a month ago
1-6 months ago
6 months to 2 years ago
2-5 years ago
more than 5 years ago
Cardiovascular Training Program Variables
How would you rate your cardiovascular fitness level?
*
Poor
Below average
Average
Above average
Excellent
Have you ever participated in a structured cardiovascular fitness program?
*
Yes
No
Are you currently participating in this cardio program?
*
Yes
No
How long have you been following this cardio plan?
*
Less than 6 months
6 months to 2 years
2+ years
When was the last time you participated in a structured cardio fitness program?
*
Less than a month ago
1-6 months ago
6 months to 2 years ago
2-5 years ago
more than 5 years ago
Specific Training Days
What days can you dedicate to training?
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please indicate all the days you intend on exercising, including personal training. We will design a plan based on this information. We may decide to program less time than your response or preclude certain types of exercises, if we decide you are not at a sufficient fitness level to safely fill the available time.
How much time can you commit to exercise on Sundays?
*
30 minutes
1 hour
90 minutes
2+ hours
How much time can you commit to exercise on Mondays?
*
30 minutes
1 hour
90 minutes
2+ hours
How much time can you commit to exercise on Tuesdays?
*
30 minutes
1 hour
90 minutes
2+ hours
How much time can you commit to exercise on Wednesdays?
*
30 minutes
1 hour
90 minutes
2+ hours
How much time can you commit to exercise on Thursdays?
*
30 minutes
1 hour
90 minutes
2+ hours
How much time can you commit to exercise on Fridays?
*
30 minutes
1 hour
90 minutes
2+ hours
How much time can you commit to exercise on Saturdays?
*
30 minutes
1 hour
90 minutes
2+ hours
Fitness Testing Services Questionnaire
What fitness tests are you interested in?
*
Body composition (body fat %, lean mass, fat mass)
Full body circumference measures
Strength testing
Cardio testing
Speed and agility testing
Flexibility / mobility testing
No testing / not interested
Any / all tests recommended by the trainer
Specific tests will be determined after our initial consultation or first session. We recommend getting a fitness test for all aspects of training you're looking to improve when starting, and every 1-3 months thereafter. Higher testing frequency is recommended for beginners, and less for more advanced athletes.
Nutritional Counselling Questionnaire
On a scale of 1-10, how would you rate your nutrition? (1=poor, 10=excellent)
*
Please enter a number from
1
to
10
.
Please describe what you think you need the most help with concerning your nutrition.
*
Please describe what you believe your doing really well with concerning your nutrition.
*
Are you willing to complete an in depth diet log for us to help you perfect your diet?
*
Yes, sign me up!
No, just give me basic information
Is there anything else you would like to let us know?
Agreements
Informed Consent to Voluntary Exercise
*
I agree to this Informed Consent.
You are willfully enrolling in a live or digital version of personal training offered by Pike Fitness. You recognize and fully understand that the program may involve strenuous physical activity including, but not limited to; maximal physical exertion, muscular strength training, endurance training, flexibility training, high impact plyometric training, speed and agility drills, and other various fitness activities. You agree to assume all risks associated with participation. These include but are not limited to; shortness of breath, asthma attack, heart attack, stroke, strain or tear of muscle tissue, injuries to connective tissue, bone fractures, shin splints, back injury, head injury, heat prostration,dehydration, or any other illness or soreness including death. You agree to take best precaution and think of safety first. If not participating in live 1-on-1 personal training, Pike Fitness encourages you to seek professional advice if you are unfamiliar or uncomfortable with proper technique. We may offer video demonstrations, but training that is not live has its flaws and may increase risk of injury without proper spotting. Nothing offered by Pike Fitness is to be taken as medical advice or diagnosis. We urge you to stop exercising immediately and contact a physician or emergency medical provider if you feel faint, breathless, sharp pain, or get any other injury from exercise. You hereby affirm that you are in good physical condition, and do not suffer from any known disability or condition which would prevent or limit your participation in these activities, or if such condition exists you have either obtained full clearance from a licensed physician, or assume further risk of participation. You acknowledge that enrollment and participation is entirely voluntary, and in no way mandated by Pike Fitness or it's affiliates, and that at any time you may willfully stop your participation.
Waiver
*
I agree to this waiver.
By signing up for live or online personal training, you fully understand the risks associated with enrollment and subsequent participation and agree to waive, release and discharge from any and all liability for any injury or damages of any kind which may hereafter accrue. You agree to defend, indemnify and hold harmless Pike Fitness, and its owners, agents, and employees, and any affiliate, of any claims of liability, and any costs incurred in connection with such claims, whether related to exercise or not.
Privacy Policy, Terms of Use, and Training Policies Agreement
*
I agree to the privacy policy, terms of use, and training policies.
Please read our
Privacy Policy
,
Terms of Use
, and
Training Policies
before proceeding. These link will open in a new tab/window so that you don't lose track of the checkout page.
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