First Name

Last Name

Age

Gender

Man

Woman

Non-binary

Agender/Genderless

Androgyne/Androgynous

Aporagender

Bigender

Demi-agender

Demi-boy

Demi-fluid

Demi-girl

Demi-gender

Demi-non-binary

Genderqueer

Genderflux

Genderfluid

Gender-indifferent

Gender-neutral

Graygender

Intergender

Maverique

Maxigender

Multigender/Polygender

Neutrois

Pangender/Omnigender

Trigender

Two-spirit

Prefer Not to Answer

Email Address

Phone Number

Type

- Type -HomeOfficeCell

Phone

Do you have gender preference for your trainer? If so indicate which.

Do you have a specific trainer you would like to request?

Days and times you are available to train?

Do you have any health issues that could possibly be affected by exercise?

Goals

Gain Weight/Muscle

Reduce Stress

Increase Energy

Improve Cardiovascular Fitness

Sports Training & Conditioning

Improve Strength

Improve Flexibility

Lose Weight/inches

Improve Tone

Pre/Post Rehab

Prevent Injury