Request Personal Training Information

Please complete the following form and click the "Send Request" button.

The WAC will respect and maintain your privacy with the following information.

Contact Information
First Name:
Last Name:
Address 1:
Address 2:
Address 3:
City:
State:
Postal Code:
How should we contact you ?
Home Phone:
Work Phone:
Mobile Phone:
Email Address:
Member Facility
Primary Club of Interest:
Information Requested
Other Clubs of Interest
(select all that apply)
 West Allis
 Waukesha
 Greenfield
 Milwaukee
 Wauwatosa
Do you have any health risks that the Personal Trainer should be made aware of? (i.e. Previous heart condition, high blood pressure, asthma, pregnancy, joint problems, previous surgeries, etc.)
Health Concerns: Yes/No Yes   No  
If Yes, Please Describe
 
What Are Your Fitness Goals?
(select all that apply)
 General Fitness
 Advanced Strength Training
 Sport Specific Conditioning
 Weight Loss/Management
 Pre/Post Natal Conditioning
 Increased Flexibility
 Muscle Toning
 Cardiovascular Conditioning
 Other
Please Give Details
 
What additional benefits are you looking to receive by working with a Trainer?
(select all that apply)
 Workout Adherence
 Support Staff
 Advanced Fitness Education
 Measurable Improvements
 Creative and Fun Workouts
 Advancing Past Plateaus
 Motivation
 Introduction to the Newest Exercises
Personal Trainer Preference
(select all that apply)
 Male  Female
Specific Personal Trainer
Availability for Training:
(select all that apply)
 Mon  Tue  Wed  Thu  Fri  Sat  Sun
Times:
Type of Personal Training Session: Hour   Half Hour   Group  
How many times a week would you like to work with a Personal Trainer?
Member Status Member   Non-Member/Prospective Member  
Additional Comments
 
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