Municipality of North Cowichan

After completion of this form, we will contact you to arrange payment and to schedule your first session. When you arrive for your first session, meet us in the lobby and come prepare to exercise wearing appropriate gym attire.

Please note:

Please complete this form with accuracy.
An assessment is required for any personal training program creation.
Medical clearance may be required.

Personal information is collected by the Municipality of North Cowichan under the authority of s.26(c) of the Freedom of Information and Protection of Privacy Act for the purposes of processing application requests. Should you have any questions about the collection of this personal information, please contact Information Management Officer, (250 746-3116; 7030 Trans-Canada Highway, North Cowichan, BC V9L 6A1.

First name

Last name

Phone number

Email address

Date of birth

Emergency contact information

Provide a name and phone number for your emergency contact person.

Full name

Emergency phone number

Personal training details

Number of sessions (3, 5, or 10)?

All sessions are 1 hour in length.

Type of personal training

Private

Semi-private

Aquatic

Preferred days and times

Preferred name of trainer

Meet our certified personal trainers on the Personal Training webpage.

What are your goals and expectations from personal training? (eg. run with grandchildren, do a pull-up, etc). Are there any barriers keeping you from your goals?

How often are you currently physically active?

Please list any other information you think may be helpful for us to be aware of.

Personal training request form

Please note:

Personal training details