Program Interest I am
signing up
for: --
choose one -- Winter
Training Series Training
Package Coaching Other Personal
Information Name
Address 1:
Date of
Birth Address 2:
Category
Address 3:
Telephone:
City: Fax:
State/Province:
Email
Zip /Post Code
Height
Country: Weight
Athletic
Profile Strengths
1.
2.
3.
Weaknesses
1.
2.
3.
Intermediate Goals
1.
2.
3.
Long Term Goals
1.
2.
3.
Current Training
Schedule Describe a
typical week of training.
Last Winter Last Summer Average
Week Hrs
Average
Week Miles
Weights
Frequency None 1 2 3 4 5 6 7 None 1 2 3 4 5 6 7 Intervals? Number of Races
Training
Availability List the typical
hours per day (if any) that you are able to train.
Total Hrs per Week
Mon
Tues Wed Thurs Fri
Sat Sun
Miscellaneous
Information Do you
have other physical or recreational hobbies? Is your work strenuous?
Describe
your general health and history of injuries that may affect your
ability to train. What's
your favorite cycling workout? What is
your favorite running workout? Your
favorite swimming workout? Do you own
a heart rate monitor?
No Yes What type?
Do
you own a power meter?
No Yes What type?
Do
you have short, steep hills (1-2min in riding time) where you train?
No Yes
Do
you have long hills (5+min in riding time) where you train?
No Yes
Do
you have an uninterrupted flat section of road 3 miles in length?
No Yes
Do
you swim with a group?
No Yes
Do
you own an indoor trainer or have access to a treadmill?
No Yes What type?
Do
you own rollers?
No Yes What type?
Personal
Rating Give us an idea of your
level in each of the areas below, where 1 is very poor and 10 is
excellent.
Rating Additional
comments Endurance
0 1 2 3 4 5 6 7 8 9 10 Speed
0 1 2 3 4 5 6 7 8 9 10 Power
0 1 2 3 4 5 6 7 8 9 10 Strength
0 1 2 3 4 5 6 7 8 9 10 Motivation
0 1 2 3 4 5 6 7 8 9 10 Pain Tolerance
0 1 2 3 4 5 6 7 8 9 10 Committment
0 1 2 3 4 5 6 7 8 9 10 Flexibility
0 1 2 3 4 5 6 7 8 9 10 Core Strength
0 1 2 3 4 5 6 7 8 9 10 Recovery
0 1 2 3 4 5 6 7 8 9 10 Positive Attitude
0 1 2 3 4 5 6 7 8 9 10 Marketing
Research How did you hear about Per4mance Training?
I
found P4T:
Per4mance
Training Website Google Yahoo MSN Other
Internet Search Media Advert or Coverage Instore
Flyer Word of Mouth Other Other
My Team / Club / Org
I have read and agreed to the waiver .
