Fitness Assessment & Personal Training Registration Packet
Thank you for your interest in the Springfield College Personal Training program. It is our goal to assist you in
reaching your personal fitness goals. These sessions will focus on developing your fitness program according to
your fitness level, goals, time commitments and interests. If you have any questions regarding the questionnaire
or the personal training program, you can reach the Fitness & Wellness Graduate Associate at x3723.
I. Participant Information
Last Name:
First Name:
Gender: Male Female
Date of Birth:
Primary Phone #:
Secondary Phone #:
Street Address:
Town:
State:
Zip Code:
Emergency Contact:
Emergency Phone #(‘s):
Select the appropriate category that describes you:
Full-Time Undergraduate Student
Full-Time Graduate Student
Part-Time Undergraduate Student
Part-Time Graduate Student
Employee
Other: __________________________________
Please select one:
(
Please note that students and employee wellness participants receive one free assessment per academic year. Employee
wellness participants also receive two complimentary personal training sessions.)
I am registering for a Fitness Assessment only.
I am registering for Personal Training sessions.
# of sessions registering for: _______
Have you completed a Fitness Assessment? Yes No
If yes, when? ________________________
Trainer Preference (if applicable):_______________________________________________
Are you registering with a partner or group? Yes No
If yes, please list their names:
_______________________________________
_______________________________________
_______________________________________