Sign Up Form General Information First Name (required) Last Name (required) Home Phone (required) Work Phone Cell Phone (required) Full Address Email Address (required) Best time to reach you MorningDaytimeEvening Best way to reach you PhoneEmailBoth DOB (required) Age (required) Gender (required)-----MaleFemale Height (required) Weight (required) Occupation (required) Number of hours worked weekly (required) Commute time (required) Are you in a relationship? (required) YesNoPrefer not to Say Do you have children: (required) YesNo For which sport(s) are you seeking coaching? (required) What are you hoping I will provide as your coach? (required) When would you like to start your program? (required) Health History Have you ever fainted, felt dizzy or unusually winded after exercise? (required)YesNo Do you have any chronic condition (ie. diabetes, asthma, thyriod)? (required) Are you using any medications? (required) YesNo Please list all medications Do you have any condition that a doctor says may limit your exercise? (required) YesNo Please provide further details Do you have any current injuries? (required) YesNo Are you currently receiving treatment? What type? With, when? Frequency? (required) Athletic History How long have you participated in sports, and which ones have you participated in? (required) Have you planned what races you will compete in for the current or following season? If yes, please list the events, dates and priority (1, 2, 3, with 1 being the most important). (required) YesNo Event 1 Event 2 Event 3 What are your three most important short-term goals (3-12months)? (required) Goal 1 Goal 2 Goal 3 What are your three most important long-term goals (1-5 years)? (required) Goal 1 Goal 2 Goal 3 Why did you choose this race? (required) What is the most important thing we must accomplish? (required) What is your current training week like? Please list the type of workout, the duration of the workout and the intensity of the workout. Monday Tuesday Wednesday Thursday Friday Saturday Sunday Is the above high, normal or low volume for you? (required)HighNormalLow What would you consider to be a HIGH VOLUME training week? Please list the workouts and the duration of the workouts.(required) What was your longest workout in the last 3 weeks? Please describe. (required) How many hours do you have to train per week? (required) Please list the best times for you to train each day of the week: (required) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Which is the best day for you to take off from training? (required) Swimming Where do you plan to swim? What size of pool is it? Are you part of a Masters Swim program? YesNo What is a long swim for you? If you swim with pace times, what kind of times do you swim? 100M 200M 400M 1500M 2K Biking Do you have a bike trainer? If yes, what brand? YesNo Brand Do you have power reading? YesNo Have you ever trained with power? YesNo Do you have cadence reading? YesNo Have you ever trained with cadence? YesNo Do you ever ride with a group? YesNo What is a long ride for you? (time or distance) Have you done any bike racing?YesNo What distances and what are your best times? Running Do you have access to a track? YesNo Do you have access to a treadmill? YesNo Have you ever done interval training? YesNo Do you ever run with a group? YesNo What is a long run for you? Have you done any running races?YesNo What distances and what are your best times? 5K 10K 1/2 Marathon Marathon Strength Training Do you have a current strength program? (required) YesNo Do you stretch or practice yoga regularly? (required) YesNo Do you use machines or free weights? MachinesFree WeightsBoth If yes, how many days/week do you do the program? Do you have a heart rate monitor? (required) YesNo Have you ever trained with heart rate? (required) YesNo What is the highest heart rate you have ever observed during exercise? Which sport? Have you ever had any testing on the bike or run for lactate threshold? (required) YesNo What were your HR/WATTAGE zones? What do you think are your limiters (aspects of your fitness that are limiting your current performance) in your swim, bike, run, or other sport? (required) Do you prefer your training plan to be in time or distance based? (required) TimeDistance Is there anything else you think I should know about you? (required) ATHLETIC WAIVER AND RELEASE OF LIABILITY In consideration of being allowed to participate in any way in any affiliated athletic/sports programs, with Eric D’Arcy DBA Limitless Coaching, related events and activities, the undersigned acknowledges, appreciates, and agrees 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 rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and can include but not limited to the following: a) Swimming, biking and running; b) Executing strenuous and demanding physical techniques; c) Vigorous physical exertion, strenuous cardiovascular workouts, rapid movements, quick turns and stops; d) Exerting and stretching various muscle groups; e) Entering the water by either diving or jumping; f) Extended time in water and underwater; g) Extreme weather and temperature conditions which may result in dehydration, heatstroke, sunstroke or hypothermia; h) Mounting, dismounting or falling off a bicycle; i) Falling or colliding with the ground, walls, stands, equipment or with other participants; j) Falling due to uneven or irregular terrain or surfaces; k) Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment; l) Contact or being struck by other participants, spectators, equipment or vehicles; m) Spinal cord injuries which may render me permanently paralyzed; Furthermore, I am aware: a) That injuries sustained can be severe; b) That I may experience anxiety while challenging myself during the triathlons, duathlons and multisport events; c) That I may come into close contact with other participants; c) That my risk of injury is reduced if I follow all rules established for participation and competition; and d) That my risk of injury increases as I become fatigued. 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 nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Eric D’Arcy DBA Limitless Coaching, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. 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. Your Signature