Training Young Champions
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Lisa@Fit180Athletics.com
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Run Plan Questionnaire
To order your personalized Training Plan, please complete the following questionnaire.
Run Plan Questionnaire
Step
1
of
3
33%
Contact Information
Name
*
First
Last
Current Age
*
Phone
*
Email
*
Running Goal
Are You Training for a Particular Race?
*
Yes
Nothing in Particular
Looking for Recommendation
What date is the race you are training for?
MM slash DD slash YYYY
What's the name of the race
Next Immediate Goals
After your race, what is your next goal?
Fitness Goals
What are your short and long term fitness goals?
Primary Purpose
What is your primary purpose for this training plan?
Better Racing Time
Health Reasons
Weight Loss
Psychological / Spiritual Benefits
Secondary Purpose
After your Primary, what would be your secondary purpose for this training plan?
Better Racing Time
Health Reasons
Weight Loss
Psychological / Spiritual Benefits
Current Fitness Level
Resting Heart Rate
What is your resting heart rate (BPM)
How active do you consider yourself right now?
Select Your Activity Level
Very Active: Something everyday
Moderately Active: Regularly 2-3 times per week
Average: Hope to do something once a week
Not so Active: I get out now and then
Basically a couch potato. For now....
Schedule
What days do you (or would you) prefer to work out? How much time do you commit to exercise?
What type of exercise do you do, and how often per week
i.e. Cardio, Strength, etc.
Type
Times per Week
Distance / Weight / ....
What is your Weekly Mileage
Walking
Jogging
Hiking
Running Routine
If you are currently doing any running describe your routine. Speed work? Tempo Runs? Long Run?
Strength Training
*
Do you currently do any strength training?
Yes
No
Describe Your Strength Training
*
What equipment do you have available for strength training? Light weights/ bands/ Medicine Ball/ Stability Ball
Equipment
What equipment do you have available for strength training? i.e. Light weights/ bands/ Medicine Ball/ Stability Ball
Cross Training
Do you do any cross-training? I.e. Biking, swim, etc...
Yes
No
Describe
What kind of cross-training do you do and how often?
History
Last Race (If any)
When was your last race? What was it, and how did you do?
How long have you been consistently working out?
Injuries
*
Have you had any injuries that prevented you from running in the last 6 months
Yes
No
Explain Your Injury
Current Pain?
Do you currently have any pain or restricted movement from any injury? (Explain)
Health Issues
What other health issues do you have that I should know about?
Payment
Type of Training Plan
*
Select Your Training Plan
5k Race
1/2 Marathon
Marathon
Personal Coaching Sessions (Optional)
How many personal coaching sessions would you like to add? These are 1-hour, one-on-one sessions
Price:
$50.00
Quantity:
Training Plan Total
$0.00
Payment Method
*
Pay by Check
PayPal
Statement of Health
*
By submitting this form, I hereby affirm that I am in good health and have no physical or medical reason that would prevent me from exercising. I understand and accept all risks associated with this training plan or any other guidance provided by Fit180 Athletics. I will further seek the recommendation of medical professionals, or act on my own advisement, as to my physical ability, and my involvement in physical activity, either running, strength training, races, or any other associated activity. I further hereby release Fit180 Athletics, and it's owners, coaches or members from any injury or death that may occur from any related activities.
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