New Athlete Questionnaire

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					                                              TriBal Training                            TriBal Training
                                                                                        Julia Purrington
                                         Balanced Training for Triathlon
                                                                                    julia@wispertel.net
                                                    and life.                            303-981-5007



                                  New Athlete Questionaire


  Athlete Information:
Name:

Address:

Ctiy, State, Zip:

Home Phone:
Phone (cell,
office):
Email address:

Main Sport:

Other Sports:

Birthdate:

       Do you have any health concerns or conditions that a coach or trainer should be aware of?



       Have you been diagnosed with Asthma, Diabetes, Heart problems, High Blood pressure or
       is there a history in your family of any of these?

       Do you have any injuries, past or present that could be affected by exercise?


       Are you taking any medications?


       Do you smoke or have you smoked in the last year?




       Has a doctor advised you not to partake in any sport or other strenuous activities?




  I highly recommend that you have a physical before beginning or changing any training program.   If
  you answered yes to any of the questions above, please explain below.
     Sports; Strengths and Limiters. Please answer the following questions in regards to your current athletic
     abilities and training as well as your strengths and weaknesses.

How many hours per week do you train during your “peak” season (average)?

How many hours per week are you CURRENTLY training (in the last 8 weeks)?

What is the MAXIMUM hours per week you have trained in the last year (highest
single week)?
How many hours per week (average) can you train in the upcoming season?

What is the maximum number of hours your schedule will allow you to train in
your PEAK training (this will likely occur only a few times during the entire
season)?
How many hours per week do you work?
CURRENTLY how many times per week do you
         Swim
         Bike
         Run
         Other SPORTS (skiing, golf, etc)
         Strength (including yoga, core work etc)
Swimming:
  Do you swim with a coach or with a Masters program?
   If so what days do you swim and what types of workouts do you do?
    What do you feel is your swimming limiter?
 (If you do not know, we can go through some questions to find out.)
What is your fastest 500, 1000, 1500, mile?
What is your avg. pace per 100 for a normal pool workout?
Biking:
   What do you feel is your biking limiter?
     (If you do not know, we can go through some questions to find out.)
    What is your fastest avg MPH for a race?
    What HR and/ or Power does this correspond to?
Running:
   What do you feel is your running limiter?
   (If you do not know, we can go through some questions to find out.)
    What is your fastest 5K/ 10K open?
    In a triathlon?
    What HR does this correspond to (AVG and MAX)
Which day would you prefer your LONGEST workout of the week to be (most
likely a bike or brick workout)?
Which day would you prefer your long run for each week to be?

If you have other pre-set workouts (Masters, group rides that you participate in,
track workout sessions) please list days, times and normal intensity of these
workouts.
Do you currently train with a heart rate monitor or power meter? If yes, do you
know your HR and Power zones?
Do you log your workouts on a website such as BeginnerTriathlete.com or
Trainingpeaks.com?
Have you ever used TraininPeaks.com?
Goals: Please list your THREE most important goals for this season. These should be exact, tangible
goals, such as “improve my run time to 45 minutes in a 10K race” rather than just “run faster”.
                                                       Goal
     1



     2


     3




Racing: What races did you compete in last year. Give race performance (i.e. was it a PR for you, a
bad race for you) and placement. Provide finish time and any splits as well as rankings within the
splits if they are available.




               Race                Date    Place,              Results/ splits
                                           performance
 1


 2

 3


 4


 5


 6
Racing: What races would you like to do this year? Please start with A priority races. „A‟ races
should be limited to 2 or 3 in a season. If you don‟t know yet, but have some ideas just fill in “An
Olympic distance triathlon in late fall” We can work out exact dates later.




                      Race                     Date       Priority   Type of Race
  1
  2
  3
  4
  5
  6
How do you define success for this season and for these races?




Waiver of Liability

I understand that training for and participating in triathlon, duathlon, swim, bike and running events is a
test of my physical, mental, and emotional limits. I understand that such training and participation poses
potential risks of serious injury, property damage and death. I HEREBY ASSUME WITH FULL
UNDERSTANDING ALL RISKS OF TRAINING AND PARTICIPATING IN SUCH EVENTS.
I attest that I am in good health and my physical condition has been verified by a medical doctor.

I WAIVE, RELEASE AND DISCHARGE Julia Purrington, consultants, and any agent for Julia Purrington
from any and all claims, costs, or liabilities for personal injury, death, or damages of any kind related to or
arising from my training or participation in any physical activity.

I AGREE NOT TO SUE any of the persons or entities mentioned above for any claims, costs or liabilities
that I have waived, released and discharged herein.

I INDEMNIFY, DEFEND, AND HOLD HARMLESS the persons or entities listed above fromany and all
claims made or liabilities assessed against them as a result of my actions except those resulting from the
willful acts or gross negligence of Julia Purrington.

I AGREE THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT’S CONTENTS and I agree that all information
provided is true and accurate to the best of my knowledge.

NAME: (Signature)

DATE:
Printed name:_

If there is any other information you would like to include, please let me know. If you have past
season workouts, race results and pace or heart rate information this would be VERY helpful!

				
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