Fox Valley School of Massage
Appleton, Wisconsin
Introduction to Massage Workshops: Learn the basics of Massage
Come check us out on Tuesday nights at 6:15. Tours are also available by appointment.
Call 920-993-8660
|
Introduction to Massage Workshops: Learn the basics of Massage Come check us out on Tuesday nights at 6:15. Tours are also available by appointment. |
|
|
Personal Training ApplicationPlease type or print clearly:A. General Information:Name Address___________________________________________________________________________ City ________________________________ State _______ Zip ______________ Home phone ( ) ______ - _________ Work phone ( ) ______ - _________________ Occupation _______________________ Place of employment______________________________ Work address ________________________________________________________________________ Date of Birth ____ / ____ / ____ p Male p Female Social Security Number: Emergency phone numbers: _____________________________________________________________ In case of emergency contact: Name_______________________________________________________ B. Educational Background: (Please state your name on school record, if different) __________ ______ Name City/State Dates Attended Degree High School ___________________________________________________________________________ College _______________________________________________________________________________ Tech/Vocational ________________________________________________________________________ Other Professional Courses ________________________________________________________________ C. Health Status: Allergies (to medications, foods, latex, airborne, etc) *** Signed: _____________________________________ Date __________________________ D. Intention of Class Instruction: Please check: p Completion of Program to Train Clients p Personal knowledge and enjoyment p Other (please specify) _____________________________________________________ E. Questions: Please type the answers to the following 5 questions: 1. Why do you want to become a Personal Trainer? 2. What will you contribute to the field? 3. What is your current workout schedule? Do you attend group classes? Private session’s with a trainer? 4. How long have you been exercising? 5. What previous training do you have? G. Tuition Payment: p I will pay my tuition in full on the first day of class and the tuition deposit of $500.00 upon acceptance into the program. p I wish to pay my tuition as follows: $500 deposit / $500 First Day Payment / Payment plan for duration for tuition. H. Anatomy & Physiology / Anatomy & Kinesiology Status p I have taken A&P and A&K within the last 2 years and have obtained a “B” or Better: class is audited. If longer class is taken for grade. p I need to take for grade: I. Application Checklist p Completed Application / Application fee of $50.00 p Typed answers to essay questions p Appointment with Health Care Provider for Physical Examination on Date: we will mail you the form we need completed after we receive your application J. Upon Receiving My acceptance Letter I will then send in: p Deposit of $500 p Completed Health History Form p Medical Release will be completed and sent in by: Send completed application and materials to: Fox Valley
School of Massage / Body Integration |
