Name *

First

Last

Email *

Are you a current YMCA at ACRC member? *YesNo

Age

Why are you interested in Personal Training? *

How long have you consistently exercised?

• No Consistent Exercise
• 1-2 Years
• 3-5 Years
• 5+ Years

If you consistently exercise, how many days per week?

• 1-2 days/week
• 3-4 days/week
• 5+ days/week

How many hours of uninterrupted hours of sleep do you get each night?

• Under 5 hours
• 5-6 hours
• 7-8 hours
• 8+ hours

What time do you typically go to sleep each night? *

What time do you typically wake each morning? *

Are you currently or have you ever followed a nutrition program?

• Yes
• No

If so, what worked, what did not and why?

Please write out what you ate yesterday from waking, until bedtime.

Are you interested in purchasing sessions for Personal Training? *

• Yes
• No

Submit