PERSONAL TRAINING INFORMATION PACKAGE

Thank you for choosing to take advantage of Talisman Centre’s Personal Training services. We
have a variety of services designed to meet your individual needs. For ongoing guidance,
progression and support we suggest you choose from 4, 8, or 12 private personal training
sessions. Get the complete experience by purchasing a Fitness Assessment or a Nutrition
Analysis to complement your fitness training. Details of these options can be found in a Talisman
Centre program brochure, or by calling 355-1287.

Informed Consent
I, ___________________________ declare that I intend to use some or all of the activities,
facilities, programs and services (herein after called “Activities”) offered by the Talisman Centre.
I understand that different people have different capacities for participating in the various
Activities offered at Talisman Centre. I assume full responsibility during and after my participation
in such Activities and for my choices to use or apply at my own risk, any portion of the instruction
or guidance that I receive while participating in these Activities.
I understand that the risk involved in undertaking any of the Activities is related to my own state
of fitness or health, and the awareness, care and skill with which I conduct myself in any of the
Activities of Talisman Centre. I also understand that I am free to withdraw from, reduce or modify
my involvement in any of the Activities and I realize that I should do so on recognition of any
signs of physical discomfort.
I further understand that the possible risks involved in participating in these Activities may
include muscle, tendon, ligament, bone and joint soreness; muscle, tendon, and ligament strain,
tear or rip; bruising, death; skin laceration; tears, cuts or punctures; shortness of breath,
dizziness, fainting, or unconsciousness; tightness in chest, bone breaks, discoloration,
separations or fractures; fatigue; sweating; eye punctures; heart attack or stroke; aggravation of
an existing or past injury; discomfort or problem with any other injury; discomfort or physical
problems associated with physical activity, and many other forms of physical discomfort.
I have read the above list of possible risks associated with my participation in the
Activities offered by the Talisman Centre for sport and wellness.
__________ (Initial)
I consent to taking all of the above noted risks by VOLUNTARILY PARTICIPATING in the
Activities of Talisman Centre.
__________ (Initial)

Cancellation Policy
Notice of 24 hours is required by the client and the trainer for any changes to the day or time of
the appointment booked and paid for. Appointments not cancelled within a 24-hour notice period
by you will not be rescheduled or refunded.

I declare that I have read, understand and agree to the contents of the 24-HOUR
CANCELLATION POLICY and the INFORMED CONSENT AGREEMENT in its entirety.

Signature: ____________________________ Witness: _______________________________

Date: ________________________________ Date: _______________________________
 PARTICIPANT INFORMATION
Name: __________________________________________ Age: _____________________

Address: _________________________________________ Postal Code: ______________

Phone: (H) ______________________________ (W) _____________________________

E-Mail: _____________________________

Physician: _______________________________ Phone: _________________________

Emergency Contact: _______________________ Phone: (H) _________ (W)__________

Please indicate the primary reason for using Talisman Centre’s Personal Training services:

□ Post Physiotherapy Exercise Program (if answered, please see section A below)
□ Talisman Centre Weight Loss Program (if answered, please see section B below)
□ General Personal Training: (see below and section C below)
Please number the following list of goals priority sequence:
o Improve Cardiovascular Fitness
o Improve Muscular Endurance
o Improve Weight Control/Body Composition
o Improve a Specific Skill
o Improve Muscular Strength
o Increase Flexibility
o Injury Prevention
o Other (Please List)

A) TALISMAN CENTRE POST PHYSIOTHERAPY EXERCISE PROGRAM

PHYSIOTHERAPIST:
CLINIC:
PHYSIOTHERAPIST SIGNATURE:
*Prior to the first session with the Rehabilitation Personal Trainer, a referral note and signature from a
physiotherapist is required.

1. What in the injury for which you are being treated?

2. What limitations do you have as a result of this injury or any other previous injury?

□ Limited Range of Motion (explain below)

_____
□ Pain or discomfort (explain below)
_____

3. How often are you going for physiotherapy treatment?

4. Please provide any information with regards to other injuries and current health status which
may limit your current ability to be physically active.

5. Are you able to commit to 2 days per week (1 hour per session) for 2-6 weeks with the
rehabilitation program?
□Yes □No
Preferred appointment day (s) and time(s): _________________________________

B) TALISMAN CENTRE WEIGHT LOSS PROGRAM

With the assistance of a Personal Trainer, this program will be customized to your
needs. Which areas do you need the most help?
□ Workouts/ Program Plan
□ Nutrition/ Eating Plan
□ Assessing/ Tracking Results

Your weight loss goal is lbs.

Your timeline to reach this goal is

The Top 3 barriers for you to reach this goal are:

□ Time □ Money □ Motivation/guidance □ Other

C) GENERAL PERSONAL TRAINING

1. Please indicate your level of physical activity in the past three months:

□ Inactive □ Occasionally Active □ Active □ Very Active

2. What is your present occupation? How active/mobile are you in your job environment?
_______________________________________________________________________

3. How many days per week can you realistically commit to being physically active?
_______________________________________________________________________

4. How much time do you have for each exercise session?

_______________________________________________________________________

5. How would you rate your current nutritional habits?

□ Good □ Usually Good □ Needs Work □ Help!!
 6. Would you consider any of the following:

□ Cooking Class □ Nutrition Seminar □ One-On-One Consultation

7. Please provide any additional information that you feel will help us in providing you with the
best service possible.

8. Do you have a preferred trainer? If not list 1 quality you would like your trainer to possess!
____________________________________

Trainer Gender Preference: □ Male □ Female □ No preference

Preferred appointment day (s) and time(s): _________________________________

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Please take the time to complete the PAR-Q form attached, and then return this package,
together with payment, to the Service Centre desk. Please note if you have answered yes to one or
more questions on the PAR-Q you will need to take the PARmed-X forms attached to your
physician for clearance to exercise prior to meeting with a trainer. The Wellness Services
Coordinator will review the information you have provided and assign the best trainer to help you to
meet your goals. The personal trainer will call you within two business days to book your initial
appointment and to answer any questions you may have.
Our staff and certified trainers strive to provide excellent customer service by designing highly
customized programs to suit your specific & individual needs and goals. We maintain current
certifications and pride ourselves on acquiring recent and meaningful information and research to
share with our participants. Thank you for choosing the Talisman Centre for Sport and Wellness for
all your personal fitness needs.

Sincerely,
Sasha Bahador Pietra Gall
Sasha Bahador Pietra Gall
Wellness Services Coordinator Wellness Services Assistant
Talisman Centre for Sport and Wellness Talisman Centre for Sport and Wellness
2225 Macleod Trail South 2225 Macleod Trail South
Calgary, AB. Calgary, AB.
T2G 5B6 T2G 5B6
T: (403) 355-1260 T: (403) 355-1287
F: (403) 262-1001 F: (403) 262-1001
www.talismancentre.com www.talismancentre.com
sbahador@talismancentre.com pgall@talismancentre.com