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Basic Information |
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First Name: |
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Last Name: |
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E-mail: |
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Address: |
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Gender |
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Date of Birth: |
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Phone: |
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Email: |
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Occupation: |
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Married: |
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Children: |
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For which sport or activity are you seeking coaching? |
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Health History |
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1. Have you or anyone in your family had heart disease? |
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2. Do you have high blood pressure? |
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3. Are you diabetic? |
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4. Are you using medications? |
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5. Do you have high cholesterol? |
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6. Do you have a condition that a doctor says may limit your exercise? |
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7. Have you had an injury in the last year that did not allow you to exercise? |
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8. Have you had surgery in the past 12 months? |
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9. Are you now, or have you been pregnant in the last 3 months? |
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10. Are there any other health concerns that I should be aware of? |
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11. Are there any nagging injuries that you consistently deal with during exercise? |
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Athlete History: |
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1. For runners and multi-sport athletes, list your best race times and splits for all distances.
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2.For cyclists, list your race category and years in each.
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3. For conditioning athletes, list the sports/activities you participate in that you seek conditioning.
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4a. Racers, list the events AND DATES you will compete in during the planned coaching season.
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4b. List the most important race of the season.
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5a. For all athletes, at the completion of our first season together, how will we know if we were successful?
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5b. What is the single most important thing we must accomplish?
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6a. How many hours per week are you currently training?
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6b. Is this high, normal, or low for you?
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7. What has been your longest swim in the past month?
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8. What has been your longest bike ride in the past month?
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9. What has been your longest run in the past month?
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10. What has been your longest swim in the past 12 months?
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11. What has been your longest bike ride in the past 12 months?
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12. What has been your longest run in the past 12 months?
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13a. Do you currently strength train?
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13b. How many days per week?
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14. How many hours per week do you have available to train? Be realistic.
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15. Do you own a heart rate monitor that has an average heart rate calculation function?
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16. Do you own an indoor cycling trainer?
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17. Do you train with a masters swimming program?
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18. Do you have access to a running track?
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19. Do you have access to a treadmill?
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20. Do you have access to a gym or strength training facility?
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21. Do you own a computrainer or other power meter device for cycling?
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22. Which is the best day for you to take off from training?
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Weekly Training Schedule: Triathletes, Runners & Cyclists |
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| 1. Check the box of the sport you would prefer to do on each day. Check multiple sports per day when necessary. |
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2. Which day would be best for your long bike ride?
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3. Which day would be best for your long run?
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Waiver: |
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| Please check to acknowledge that you have read the waiver. |
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Click to read the Waiver 
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