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Personal Training Registration

Complete the following form to register for personal fitness training. Once you have registered, you must complete the required physical fitness assessment and history. Be sure to review the policies and participation agreement at the bottom of this page before initialing and submitting this form.

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Membership Status:*

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If you prefer to work with a specific personal trainer, indicate the name of the trainer. Although a request is made, all requests may not be accommodated due to availability conflicts between the client and trainer or a full client load of the trainer.
Please list the times you are available to train. Include specific hours or time frames.
Has your physician ever told you that you have a heart condition?:*

Do you experience chest pain when you are physically active?:*

In the past month, have you experienced chest pain without physical activity?:*

Do you lose balance because of dizziness or do you ever lose consciousness?:*

Do you have a bone/joint problem that could be aggravated by change in level of physical activity?:*

Is your physician currently prescribing meds for blood pressure or heart condition?:*

Are you a male over the age of 45?:*

Are you a female over the age of 55?:*

Do you know any reason you should not participate in a program of physical activity?:*

Have you ever had a stroke?:*

Do you have diabetes?:*

Do you have asthma or another respiratory condition that causes difficulty breathing?:*

Do you have an orthopedic condition that restricts you in performing physical activity?:*

Have you ever been told by a physician that you have one of the following?:




Do you currently smoke or have you smoked in the past and stopped within the past six months?:*

Do you currently have back pain or have you had back pain within the past six months or felt discomfort that prevented you from carrying out normal daily activities?:*

Are you pregnant?:*

Are you currently taking any medication regularly, including any supplements, vitamins, minerals, homeopathic remedies, birth control or over-the-counter drugs?:*

Do you wish to lose or gain weight?:*


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By submitting this form, you are indicating that you have read, understood and will abide by the policies and participation agreement stated below:

Payment Policy
Sessions will be prepaid and payment is due at the time of scheduling initial appointment. Check, cash, or credit cards are accepted. Make checks payable to Morehead State University. Paying a personal trainer directly is strictly prohibited; all membership privileges to the Recreation and Wellness Center will be terminated if this is violated.

Session Duration
Personal training sessions are 60 minutes long. Fitness assessments and orientations are approximately 45‐60 minutes long. Sessions cannot be less than 60 minutes.

Risk Factor Notice
Clients must be cleared of any risk factors associated with physical activity prior to an assessment and/or session. If a client is identified as high risk, the client must provide the trainer with a signed physician’s medical release stating the client has been cleared to engage in physical activity.

Training Site
The MSU Recreation and Wellness Center and MSU campus will be the training site for personal training during the time of appointment. All sessions will begin at the Recreation and Wellness Center. Trainers are not allowed to train under any other conditions or circumstances.

Refund Policy
Personal training packages are non‐refundable.

Transfer Policy
All personal training sessions are non‐transferable. All packages must be paid in full to the Recreation and Wellness Center membership desk when the initial assessment and the first session of each package are scheduled. Sessions within a package cannot be split or transferred to other individuals.

Late Policy
Personal training clients are responsible for arriving in a timely manner. The trainer is to wait no longer than 15 minutes beyond the scheduled start time. Clients who arrive late will forfeit that session. If a client is late, the trainer may continue with the session and end at the scheduled time.

Cancellation Policy
Except in the event of an emergency, a minimum of 24 hours notice is required for the cancellation of a training session. Failure to cancel within 24 hours or failure to show up for will result in a forfeit of the session. Exceptions will only be made in the case of a medical emergency. If there should be a discrepancy, the decision will be determined by the director of fitness and wellness. Personal training clients should contact their personal trainer in order to cancel a session.

Expiration of Personal Training Sessions
All sessions and assessments must be used within six months of purchase date.

 
PARTICIPATION AGREEMENT AND ASSUMPTION OF RISKS AND LIABILITY
By submitting this online form, I indicate my desire to participate in the personal training program at the Morehead State University Recreation and Wellness Center and, in consideration of being allowed to participate in this program and use the facilities and equipment of the Morehead State University Recreation and Wellness Center, I do hereby acknowledge and agree as follows:
  • I am fully informed and aware that my participation in the personal training program and use of the facilities and equipment involve certain risks, including, but not limited to, property damage and loss, bodily injury, illness and even death. I fully assume any and all risks. I am in sufficient physical and mental health to participate in the personal training program and to use the facilities and equipment.
  • I fully and forever release, waive and discharge, and covenant not to sue Morehead State University (including but not limited to its trustees, faculty, staff, students, agents and representatives) from and for any and all demands, claims, actions, suits, damages, losses, liabilities, costs and expenses (including, but not limited to court costs and attorney's fees) from any cause whatsoever (including but not limited to property damage or loss, bodily injury, illness or death) directly or indirectly arising in connection with my participation in the personal training program, whether or not foreseen or contributed to by the negligent acts or omissions of Morehead State University or others. This agreement constitutes the entire agreement and supersedes any prior or contemporaneous agreements, regarding this subject matter. The agreement (i) may not be amended by course of conduct or otherwise and (ii) may not be assigned, in whole or part, except in writing duly executed by Morehead State University. This agreement shall be interpreted and enforced in accordance with the laws of the Commonwealth of Kentucky, without regard to any conflicts or choice of law principles and shall be as broad and inclusive as permitted by such laws. If any provision of this agreement is held unenforceable by a court, such unenforceability shall not affect any other provision, and this agreement shall be construed as if such provision, to the extent of such unenforceability had not been incorporated herein. I (i) have read and fully understand this agreement, (ii) intend that this agreement be legally binding upon and enforceable against me and my family, estate, heirs and legal representatives, (iii) intend that this agreement benefit Morehead State University, (iv) confirm that I am at least 18 years of age, fully competent and am entering into this agreement voluntarily and of my own judgment.

If you agree to the aforementioned terms and policies, you may initial and submit this form.
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