2. Personal Training Request
   1 Hour Session - $75

   3 Sessions - $220

   5 Sessions - $350
4. Name:*
5. Phone Number:*
7. Address:*
8. Email Address:*
10. City/Town:*
11. State/Province:*
13. Zip Code:*
14. Country:
16. Todays Date*
    Todays Date
18. Requested Personal Trainer*

    1. Mia Sypniewski
    2. Carla Summers
    3. Cameron Dennis
    4. Luis Garcia
    5. Breanna Glanz-de la Rosa
    6. Christian Alvarez
    7. Male Trainer
    8. Female Trainer
    9. No Preference
20. What is your availability?
22. Mornings

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
23. Afternoons

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
24. Evenings

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
26. Goals of Training Session:*

    1. Strength Training
    2. Endurance Training
    3. Flexibility
    4. Reduce Stress
    5. Sports Specific Training
    6. Target Weight
28. Has your Doctor ever said you have heart trouble?*

    1. Yes
    2. No
30. Has your Doctor ever told you that you have bone or joint problems?*

    1. Yes
    2. No
32. Has your Doctor ever told you that you have high/low blood pressure?*

    1. Yes
    2. No
34. Are you older than 65 and unaccustomed to vigorous exercise?*

    1. Yes
    2. No

36. •If you answered yes to any of the questions above please consult your physician before increasing your activity level. Tell your physician which questions you answered yes to and discuss your ability to proceed with an exercise program.
    
    • Cancellations must be made 12 hours in advance or that session will be forfeited. This applies to all packaged sessions. Please contact your trainer first. If you’re unable to contact your trainer, call the Avon Recreation Center front desk at 970-748-4060. 
    
    • Refunds may be received only if the client can prove with a valid note from a physician that injury or illness prevented the client from partaking in the training sessions. 
    
    • All packaged sessions must be completed within a 6-month period from date of purchase. 

38. Check to agree*

    1. I agree to these Terms and Conditions and by clicking this box it is equivalent to my signature.
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