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2. First Name*
3. Last Name*
5. Primary Phone Number*
6. Email*
8. Gender*

   1. Male
   2. Female
10. Age*
12. Are you a VRC Member?*

    1. Yes
    2. No
14. Vandalia Rec Center Membership Information
    Vandalia Rec Center Membership Information
16. What type of Trainer are you interested in?*

    1. Personal Trainer
    2. Basketball Trainer
    3. MELT Trainer
    4. Pickleball Trainer
18. Personal Trainer Preference

    1. Alex Brundrett
    2. Amber Fraley
    3. Paul Kleinhenz
    4. Kevin Dokes - Basketball
    5. James Lawson - Pickleball
    6. No preference
20. Have you already met with or set up an appointment with a VRC trainer?*

    1. Yes
    2. No
22. Who have you already set up an appointment with?
24. Availability
    Due to each Trainer's limited availability, please provide general days/times. Once you meet with a trainer you will work out specific scheduling sessions.
26. Monday
28. Tuesday
30. Wednesday
32. Thursday
34. Friday
36. Saturday
38. Sunday
40. Please briefly explain any health and fitness goals.*
42. Please note:
    Your Trainer may request a medical release from your physician before they will be able to work with you. This is not only for your safety, but for the safety of your Trainer and the Vandalia Recreation Center. VRC Preferred Trainers are not employed by the City of Vandalia, and therefore are Independent Contractors.
44. Waiver and Release
    In consideration of the City of Vandalia granting me the permission to engage in the recreational activities with the Vandalia Recreation Department, the signed does hereby waive, release, save and hold harmless and indemnify the City of Vandalia, its employees, agents and independent contractors for any and all claims for damage of personal injury to me or loss of property which may be caused by any act of failure to act on the part of the City of Vandalia, its employees, agents and independent contractors. The signed further assumes the risk of all dangerous conditions in and about the City of Vandalia Recreation Department property both real and personal and waives any and all specific notice of the existence of such dangerous conditions, if any.
46. Electronic Signature*

    By signing your name here you agree that you understand the Waiver and Release terms.

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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field