Returning Athlete – Coaching Sign Up – Transition Myself Training

Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Numbers*

specify type cell, home, work etc

Best time to reach you

Email*

Preferred Contact Method*

Date to start training program*

Current Athletic Information

List your goal races with dates and priority*

A - goal race (1-2 at most) B - meaningful race C - training race

Race Name	Race Date	Priority (A/B/C)

List your 3 most important goals*

Goal 1	Goal 2	Goal 3

At the completion of our season, how will we know if we were successful*

What is the single most important thing we must accomplish*

How many hours would you consider to be a BIG WEEK*

How many weekly hours do you have available to train*

Please enter a number from 0 to 40.

Do you require Swim Training as part of your program?*

Choose yes if you are signing up for triathlon or swim coaching.

Yes
No

Where do you plan to swim*

Which days do you prefer to swim (select at least 3)*

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

If pool swim, what size

Do you swim with a group regularly*

Yes
No

Which group*

Do you belong to any running groups*

Yes
No

Which group*

Preferred day off from training*

List the type of equipment you own

Bike	Bike Trainer	Power Meter	GPS device	Heart Rate Monitor	Swim paddles / fins	Run Shoes	Wetsuit

If you have any injuries, please list them here.

Additional questions or comments

Release Form

In consideration of being coached in an endurance sport program by Transition Myself Training, I do hereby waive, release, and forever discharge Transition Myself Training, and all employees and associates of Transition Myself Training, including but not limited to Chris Pickering, of all responsibility or liability from injuries or damage resulting from my participation in any activities or program. I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of Transition Myself Training.

*

I understand and am aware that the program given to me from Transition Myself Training, including the use of equipment, involves a risk of injury, and that I am voluntarily participating in the program and using my equipment with knowledge of the dangers involved. I here by agree to expressly assume and accept any and all risk of injury.

*

I do hereby further declare myself to be physically sound and suffering from no medical condition, impairment, disease, infirmity, or illness that would prevent my participation in any physical exercise program. Nor am I prevented, for any reason, from the use of exercise equipment or machinery except as may be noted hereinafter.

*

I do hereby acknowledge that I have consulted with my physician regarding my intention to participate in a Transition Myself Training program.

The only restrictions I have respecting my ability to participate in this program are as follows

Today's Date*

MM

DD

YYYY

Full Name (Digital Signature)*

Signature*