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Clear Creek Metropolitan Recreation District

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Clear Creek Metropolitan Recreation District

Hurricanes Swim Team Update: Click here for additional information.

Adults
Fitness and wellness
Personal training
Intake form

Personal training intake form

Complete this form to get started with personal training.

Name * Required
First Last
Birth date
MM slash DD slash YYYY
Email * Required
Phone
Emergency contact phone
Lifestyle and fitness
How would you describe your current fitness level?
- Beginner
- Intermediate
- Advanced
What is your primary fitness goal?
- Weight loss
- Muscle gain
- Improved endurance
How often do you currently exercise?
- Never
- 1-2 times per week
- 3-4 times per week
- 5+ times per week
What types of exercise do you enjoy?
(e.g., weight training, cardio, yoga, swimming)
Do you have any previous experience with personal training?
- Yes
- No
If yes, describe:
Do you have any specific fitness achievements or milestones you’d like to reach?
Nutrition
Do you follow any specific diet or nutrition plan?
- Yes
- No
If yes, describe:
Do you have any dietary restrictions or food allergies?
- Yes
- No
If yes, describe:
On a scale of 1-10, how would you rate your current nutrition habits?
(1 = poor, 10 = excellent)
General
Do you smoke or use tobacco products?
- Yes
- No
Do you consume alcohol?
- Yes
- No
If yes, how often?
Do you have any other hobbies or activities that could impact your fitness journey?
Is there anything else you would like your trainer to know?
Consent
I consent to the collection and use of my personal information for the purposes of creating a personalized training program.
Acknowledgement
I acknowledge that I have provided accurate and complete information to the best of my knowledge.
Scheduling
Let us know your general availability for personal training sessions.
Time of day
- Morning
- Afternoon
- Evening
Day of the week
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday

Get help

trainer@ccmrd.com

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