Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Do you use social media? Select all that apply. *

Facebook Twitter Instagram

User name for each social media site. *

What is the best way to reach you? *

Do you have a Training Peaks account? *

If yes, what email is associated with it? *

Date of Birth mm/dd/yyyy *

Age *

Height *

Weight *

Medical Information

Do you have any medical issue we need to be aware of? *

If yes, please explain *

Have you had any injuries in the last year? *

If yes, please explain *

Has a doctor advised you not to participate in physical activity? *

If yes, please explain *

Do you take over the counter or prescription drugs? *

If yes, please explain *

Do you regularly exercise? (3 days per week or more) *

Do you ever feel light-headed while exercising? *

Do you have high blood pressure? *

Do you have high cholesterol? *

Are there any other health concerns or injuries not mentioned? *

If yes, please explain *

Focus

What is your sport focus? (list all that apply) *

What size pool do you have access to? (check all that apply) *

25 yard 25 meters 50 meters Other

Do you have access to a safe, open water swim environment? *

Do you have an indoor bike trainer? *

If yes, what type? (i.e. smart, magnetic, fluid, etc) *

Do you have a heart rate monitor? *

If yes, is your heart rate monitor GPS enabled? *

Training

In the following section please indicate what training you can do each day of the week and at what time of the day. Please be as specific as possible with details. This is flexible if you want to change your schedule later due to work or family schedules.

Example: Monday - Swim in the AM, run or bike in the PM. Wednesday - Swim in the AM only, no PM workouts. Saturday - Swim, bike or run anytime. Sunday - Must have the day off.

Monday *

Tuesday *

Wednesday *

Thursday *

Friday *

Saturday *

Sunday *

Goals

Please indicate your top one or two races for the up coming season. *

What would you say is your weakest area, or the area that needs to most improvement and why? *

Why do you want to hire a coach? *

When would you like to get started training? *

Please review your application to ensure you have answered all questions as accurately as possible. Once you are ready, please Submit this form and I will follow up with you as soon as possible. Thank you!

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