Personal Training Online Registration Form

In order to participate in personal training at the William and Mary Student Recreation Center, clients must either be William and Mary students or faculty/staff members or have a privilege card to use the W&M Student Recreation Center. Check the W&M Campus Rec website for privilege card information and prices: {{http://www.wm.edu/rec}}. Student and Faculty/Staff members should put their 930 number on the form. Privilege Card members will have an ID number on their card.

*Status:
*Gender:
*How did you learn about the Personal Training program?
Session Package
It is recommended that all new clients have a fitness assessment before beginning their training sessions, unless you have had a fitness assessment within the past 3 months and can provide documentation to the Trainer. If you do not want to do the orientation package (which includes a fitness assessment), the fitness assessment can be included as the first session in your package.
Partner Training:
Train with a friend and get a 30% discount off any individual session or session package. Fitness assessments must be done individually.
If you plan on partner training, your partner will need to submit a separate registration form and list your name as his/her partner.
Preferences:

More Information about this question...

Please indicate if you have a preference for a male or female Trainer or write the Trainer's name
Are you currently exercising?:
What types of exercise interest you?:
Payment Options:
You can pay at the front desk of the Rec Center by cash, check, W&M express or credit/debit card. *Please pay before your first session with your Trainer.
Physical Activity Readiness Questionnaire
*Please read the following health questions below. If you answer "NO" to all of them, you should be able to exercise safely without consulting your physician or other appropriate health care provider. If you answer "YES" to any of them, we will need a medical release form signed by your physician before you begin training with us. 1) Has your doctor ever said that you have a heart condition or that you should NOT do physical activity? 2) Do you feel pain in your chest when doing physical activity? 3) In the past month, have you had chest pain when you were not doing physical activity? 4) Do you lose your balance because of dizziness or do you ever lose consciousness? 5) Do you have a bone or joint problem that could be made worse by a change in your physical activity? 6) Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? 7) Do you know of any other reason why you should not do physical activity?

More Information about this question...

The Medical Release Form can be found on the W&M Campus Recreation Personal Training website under "forms" in the left-hand navigation menu.
College of William and Mary Campus Recreation Liability Waiver *Please read the waiver and make your electronic signature below.
I expressly understand and agree to indemnify and save the College of William and Mary and the Commonwealth of Virginia harmless from and against any and all claims, liabilities, costs, expenses, fires, injuries and/or deaths, which arise from or are caused by, in while or in part, directly or indirectly, the use of College facilities or the activity hereby applied for by the applicant, its employees, servants, agents, invitees, or independent contractees. I further understand that use of College facilities, as a voluntary request, is made at the sole risk of the applicant, and that neither the Campus Recreation Department, the College of William and Mary nor the Commonwealth of Virginia make any representation, expressed or implied, as to the suitability or fitness of such facilities.
simpleCaptcha

Please type the following word (no spaces) into the box provided.

    T r i b e