Les Mills Mid-Atlantic, Inc. Assessment Cover Sheet

Les Mills Mid-Atlantic, Inc. Assessment Cover Sheet
Please send this with your assessment DVD
Name: __________________________________________
Address: ________________________________________
City: _________________________ State: _____________ Zip: ________
Phone: ( ) ________________________________________
Email: ____________________________________________
Fax: ( ) __________________________________________
Club Name: ________________________ Club Ph: ( ) ________________
Group Fitness Director’s Name: ____________________________________
Circle the appropriate Les Mills program for this assessment:
BODYPUMP®
BODYCOMBAT®
BODYSTEP®
BODYATTACK®
BODYJAM® BODYVIVE®
RPM®
BODYFLOW ®
Date Trained: __________________________________
Name of Trainer: _______________________________ Grade: _____
Location of Training: ____________________________
Please provide details of your Teaching Experience:
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Class Time Slot: ______________ # of participants in class: _____________________
How did you feel about the class you taught?
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List the teaching goals you are now striving to achieve:
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