Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate

YYYY

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Training Peaks account email & username

If you currently have a Training Peaks account we can easily link it to PLAN7

Resting Heart Rate, if known

Heart Rate at Threshold, if known

Functional Threshold Power (FTP), if known

List 3 of your strengths

List 3 areas you'd like to improve

List 3 short term goals you'd like to shoot for in the next 6 months

List 3 long term goals you'd like to shoot for over the next year

In the next 6 months do you plan to:

Race

Enter an Event

Have a Big Ride Planned

Please list details of races/events/rides you plan to do

What other types of physical activity do you participate in besides cycling or running? Please describe.

What do you do for work? Is it physically demanding?

Any injuries that impact your ability to train? Please describe.

What causes you stress? How do you deal with it?

What is difficult for you while training?

What do you enjoy most about training?

Do you follow a particular diet or have diet restrictions? Please describe.

Do you have a power meter? What type?

If you don't have a power meter, do you have a heart rate monitor? What type?

Do you have an indoor trainer? What type?

Do you have any questions prior to starting the program?

Please list any questions you have regarding sport nutrition

Are you interested in nutrition programming integrated with your training plan?

Height

Weight

Please list any medications you take and reason

Date of Last Physical Examination

YYYY

Results of Last Physical Examination

Who do we have to thank for your interest?

Acknowledgement of PLAN7 Endurance Coaching's Release of Liability

WAIVER AND RELEASE OF LIABILITY — READ BEFORE SIGNINGIn consideration of being allowed to participate in any way in the Plan 7 Endurance Coaching program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS PLAN 7, INC., dba Plan 7 Endurance Coaching, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.5. I have read, understood and completed the medical portion of the questionnaire. To the best of my knowledge, the medical information is true. I understand that if my health changes in such a way as to limit my exercise capacity, I will tell my fitness professional.

Don't Accept

PLAN7 New Athlete Questionnaire