top of page

Endurance Tribe Coaching

Home
Forms
About Me
Services
How I Work
Contact
Blog
Plans & Pricing
Groups
Members

Download Waiver

First name*

Last name*

Phone*

Email*

Birthday*

Month

Day

Year

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Profession *

Athlete History

Are you currently an active athlete (Runner, Triathlete, Duathlete, other)*

Yes

No

How many years of experience do you have as an athlete:*

List of current activities:*

Describe your current training week:*

How many hours per week do you spend training:*

How many days do you take off per week, what is ideal:*

What days of the week are you available to train:*

Mon

Tue

Wed

Thurs

Fri

Sat

Sun

How many hours per week are you realistically able to train. If hour vary by day please provide details.*

If currently an active athlete please provide most recent race times:*

Health History and Activity Readiness

What is your Height (in inches)?*

What is your weight (in pounds)?*

Please explain any "Yes" answers in the space below.

Has a doctor ever said that you have a heart condition and recommended only medically supervised physical activity?*

Do you have chest pain brought on by physical activity?*

Have you developed chest pain within the last month?*

Do you tend to lose consciousness or fall over as a result of dizziness?*

Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*

Has a doctor ever recommended medication for high blood pressure or a heart condition?*

Are you aware, through your own experience or a doctor’s advice, of any other physical reasons against your exercising without medical supervision?*

Explain*

Do you have any metabolic diseases, controlled or uncontrolled, such as diabetes, hyperthyroidism, hypothyroidism, etc.?*

Do you, or have you ever, smoked regularly?*

Do you take any drugs or medications?

Are you, or have you been, recently pregnant?*

Do you have high cholesterol?*

Have you had any surgery in the past year?*

Have you ever had an injury that caused you to stop exercising for more than one week?*

Are you, or have you ever been, anorexic or bulimic?*

Are there any other physical or emotional problems that may affect your training?*

Explain:*

Past and Current Medical History

Please list any current illness, recent injuries, recent surgeries or past medical problems or surgeries of note*

Do you have, or have you had, any of the following?

Heart Disease*

Yes

No

Heart Attack*

Yes

No

Heart Surgery*

Yes

No

Heart Murmur*

Yes

No

Hypertension*

Yes

No

Thyroid Problems*

Yes

No

Asthma*

Yes

No

Wheezing*

Yes

No

Diabetes*

Yes

No

Epilepsy*

Yes

No

Anemia*

Yes

No

Stress Fracture*

Yes

No

If female, is there a chance you could be pregnant?*

Yes

No

N/A

Are you currently taking any medication or drugs? If so, please list them and the reason.

Any special medical needs or information the coach should be aware of?*

Do you have any allergies?*

Goals

What is your number one goal this season?*

Are you currently registered for any events? If so which events are your "A" races?*

Equipment and other information

Do you own a Heart Rate Monitor?*

Do you own a smart watch (Garmin, Apple, etc.)?*

What equipment do you have access to?*

Mountain Bike

Road Bike

Triathlon Bike

Trainer

Bike Computer

Treadmill

Track

Pool

Weight equipment

Other

Waiver Upload*

Signature

Sign in the box or use the keyboard to type.

Signature field is empty.

602-680-8660

info@endurancetribecoaching.com

bottom of page