Athlete Information questionaire

CONTACT & PERSONAL INFORMATION

First Name

Last Name

E-mail Address

Address

City

State

Zip

Home Phone

Work Phone

Date of Birth

(mm/dd/yyyy)

Age:

Gender:

Height:

Weight:

BACKGROUND INFORMATION

Athletic background (list any sports you played (if any), how long, at what level, etc . . .)

List any prolonged sickness or injury in the last 6 months:

List any current medical or injury conditions:

Are you currently taking any medications?

Are you currently being treated for a sports medicine type injury?

TRAINING INFORMATION

List your two "A-priority" events for the season: (Be sure to include race name, distance and date)

Please list a tentative race-list of events you're targeting for the season: (Be sure to include race name, distance and date)

What are the busiest days of the week for you?

Mon

Tue

Wed

Thu

Fri

Sat

If you are employed, what does a typical work week look like for you?

Sun
Mon
Tue
Wed
Thu
Fri
Sat

For a period spanning the next 12 weeks, please list the dates that you will be traveling away from your normal training environment, whether for work, vacation, or other. Also, list equipment that you'll have access to during that time. (ie: bike, run, pool, weight room, etc.)

What is the number of hours you would like to allot to training each week?

Do you have access to a health-club, gym or YMCA? If yes, which:

If applicable, what are your best days to swim?

Mon

Tue

Wed

Thu

Fri

Sat

Do you currently use a heart-rate monitor?

Rank your nutritional habits:

Best										Worst
	1		2		3		4		5

In the last three weeks, what was your longest (list distance or time duration):

Swim
Bike
Run

Where applicable, in the last 90 days list your best:

5k run time
10k run time
Mile or half-mile swim time
40k bike Time-trial

Do you have specific limiting factor that you want your training program to address?
(example: improve run technique, cycling endurance, swim stroke, etc. . .)

Select your current weekly workout sequencing:

Sun
Mon
Tue
Wed
Thu
Fri
Sat

PROGRAM SELECTION

How did you hear about Studio 7 Multisport?

	Referred by a team member
	Who?
	Attended a clinic
	Which one?
	Saw the team jersey at a race
	Which race?
	Link from another web site
	What site?
	Race flyer
	Which one?
	Referred by a team sponsor or technical advisor
	Who?
	Other
	Describe:

My coach is: Please type in your coach's name. If you are unsure, please type in "Let Studio7 choose my coach

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	Program-B, Annual Plan Coaching - Averages $27.19/week (48weeks of coaching) - Billed $385 for payment -1, $385 for payment-2, $385 for payment-3, and $150 for payment-4 . . . credit card payment only.
	Program-C, Calendar-by-Calendar Coaching - Averages $33.33/week - Billed $400 for each 12-week calendar. Renewed calendar by calendar.

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I have read and accept the terms and conditions outlined in the Waiver of Liability and Billing Policy document listed above. I also understand that if I cancel my Program Option before I've completed it, there will be a $75 cancelation fee.

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