SUCCESS A RECIPE FOR. Nutrition Sessions with holistic nutritionist Kim Dalmatoff. Registration is open. Sign up at the front desk!
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1 A RECIPE FOR SUCCESS Nutrition Sessions with holistic nutritionist Kim Dalmatoff Eating healthy doesn t have to be hard! We re to help you on your wellness journey with health coach sessions. Learn about your body and nutrition, and set achievable, meaningful goals to improve your lifestyle! Registration is open. Sign up at the front desk! All participants must turn in a health history form to Sherry Gutsch. Once turned in, we will contact you to schedule your first appointment and get you started on your nutrition journey! Don t miss out on this amazing opportunity to take control of your health! For more information, contact Sherry Gutsch at x20 or Sherry.Gutsch@ciymca.org FEES (per one-hour session) $50 facility member $65 program member Benefits of Nutrition Sessions Set goals for your health and gain accountability Learn meal prep techniques to make healthy eating easier Discover stress factors and challenges that get in the way of your diet Empower your whole family to achieve better nutrition VENTURA FAMILY YMCA 3760 Telegraph Road, Ventura, CA ciymca.org/ventura
2 Nutrition Request Form Date Name Member # Birthdate Desired Dates & Times Phone Desired Instructor (staff bios on back) Please note the following: 1. Nutrition session are sold as one hour sessions. 2. We will NOT be issuing "partial refunds" for a forgotten session. It is your responsibility to show up to each scheduled session and if you cannot make it you must call and cancel. 3. All sessions must be cancelled 24 hours prior to the time the session is scheduled. If you do not cancel 24 hours prior to the session, then that session counts as one of your sessions. If prior cancellation hasn't been made and you are more than 15 minutes late, then that counts as one of your sessions. 4. Online scheduling reminders are now available. Please provide your address so we can get your account set up. 5. Any scheduled sessions not paid for will be cancelled. Member s Initials Full Facility Member Pricing Nutrition: 1 One hour session $50.00 Please Circle Your Choice Program Member Pricing Nutrition: 1 One hour session $65.00
3 Kim Dalmatoff: Personal Training and Nutrition Kim started her fitness journey many years ago but has recently became Certified as a Personal Trainer. Once she obtained her certification, she realized how many other opportunities there are in fitness. Kim is also a Certified Spin Instructor and Body Pump instructor. She loves having fun while helping others be active and get in shape to reach their goals. She has worked to help condition an athlete who just wanting to improve their form, increase their stamina, then a incorporated a HIIT/Crossfit style which is her favorite. She also has the ability to scale workouts to basic foundational movements to help those recovering from injury to feel strong and confident again in a safe manor. Certifications: National Academy of Sports Medicine (NASM) Personal Trainer Mad Dog Spin Instructor Certified Body Pump Certification Nutritional Health Coach Certification Barre TRX Specialty: Working with all ages and range of intensities to get you in shape quickly and safely
4 Health History Form Name (First and Last): Address: Phone Number: ( ) - Age: Height: Current Weight: Weight 6 months ago: One year ago Would you like your weight to be different? If so, how? Occupation: Hours of Work Per Week: Please list your health concerns: Other concerns and/or goals: At what point of your life did you feel your best? How is the health of your mother? How is the health of your father? How well do you sleep? How many hours? Any pain, stiffness, or swelling? Allergies or sensitivities? Do you take any supplements or medications?
5 What role do sport and exercise play in your life? What foods did you eat often as a child? Breakfast Lunch Dinner Snacks Liquids What is your food intake like these days? Breakfast Lunch Dinner Snacks Liquids Will your friend/family members be supportive of your desire to make food/ lifestyle changes? Do you Cook? How much of your cooking home cooked? where do the rest of your food from? Do you crave sugar, coffee, nicotine, or have any major addictions? The most important thing I should do to improve my health is: Anything else you want to share? Next Steps
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