| I. Athlete Profile
(Health History Questionairre) |
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| List any medications you currently take |
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List any injuries or hospitalizations you’ve had in the
last five years: |
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Have you been diagnosed within the past 5 years
with any of the following:
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List quantity and types of food and drink you have
consumed in the past 24 hours. |
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| What days are you unable to Swim, Bike or Run? |
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List the race specific format and distance that will be
your number 1 priority for 2010 |
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List your 3 most important races for 2010; list date
and location and then also indicate other races
you would like to do. |
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List 3 major multisport goals for the next two-four
years. |
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What % of races do you want to travel to vs.
compete on a local level? |
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You will need to compete in some single sport
competitions next year; are they available in your city? |
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Do you have multisport training groups available?
Identify by sport how much training time you prefer
to be: solo vs. group. |
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Do you have the following training facilities available?
25 or/and 50m pool, lake, crit. Course, time trial
course, hills(bike), track(run), hills(run), trails. |
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Do you want to include mountain biking once+
per week? |
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Do you think YOU respond better to 3, 4, or 5
week-training cycles? If you don’t know how to
answer this then leave blank. |
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What length of racing season do you seem to respond
to best? (list in number of weeks). |
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How long of a base period do you prefer before
racing? |
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| What month do you generally prefer to start racing? |
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What time of day best suits your training sessions?
List by each day of the week. What is your dream
training schedule? |
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Suggest any other preferences for training,
racing, group activities. |
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How many times do you like to race in a season?
List by sport. |
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Have you ever had a multi sport coach before?
If so who? What did you like and dislike about
the coach or program? |
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| Let me know other areas that you want to focus on. |
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| What kind of bike are you currently riding? |
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Do you have any physical/mental concerns that I
should be aware of as your personal coach? Please
remember this is all confidential. |
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| RELEASE OF LIABILITY, HOLD HARMLESS AND INDEMNITY: |
The undersigned is participating in athletic training and coaching programs that involve strenuous physical activities with the potential for bodily injury. The activities include the use of equipment that is also potentially dangerous and that can also cause injury. The risks of participation in the activities and use of equipment include, but are not limited to, risks of serious bodily injury and/or death. By signing below you acknowledge that you are fully aware of and accept the risks of injury and/or death. The undersigned further hereby releases Lee Zohlman, Erinne Zohlman, BodyZen Multi Sport Coaching, and BodyZen Enterprises Inc. their agents, employees, contractors, and individuals or entities acting on their behalf (hereafter RELEASEES) from any and all liability including, but not limited to, liability for bodily injury, medical expenses, and/or death arising from participation in the athletic training and coaching programs. The release of liability EXPRESSLY INCLUDES A RELEASE OF ANY AND ALL LIABILITY FOR THE NEGLIGENCE AND/OR NEGLIGENT ACTS OF RELEASEES, in the athletic training and coaching programs.
The undersigned agrees to indemnify and hold harmless Releasees from any and all liability, expenses, costs and/or losses arising out of participation in the athletic training and coaching programs, activities and/or use of equipment. The undersigned further agrees to indemnify and reimburse Releasees for any and all damage the undersigned causes to Releasees’ equipment during the undersigned’s participation in the athletic training and coaching programs |
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