Athlete Start-Up Assessment

The more information we have about your athletic history, your training, goals and dreams, the more we can tailor a program to fit your needs. This questionaire helps us build an athletic profile of you and customize a program to develop your weaknesses, capitalize on your strengths and to help you attain your goals. As a general rule, the more information you can give us the better, so don't be shy!

Optional Fields Required Fields

Program Interest
I am signing up for: -- choose one --Winter Training SeriesTraining PackageCoachingOther
Personal Information
Name		Address 1:
Date of Birth		Address 2:
Category		Address 3:
Telephone:		City:
Fax:		State/Province:
Email		Zip /Post Code
Height		Country:
Weight
Athletic Profile
Strengths
1.
2.
3.
Weaknesses
1.
2.
3.
Intermediate Goals
1.
2.
3.
Long Term Goals
1.
2.
3.
Current Training Schedule Describe a typical week of training.
	Last Winter	Last Summer
Average Week Hrs
Average Week Miles
Weights Frequency	None1234567 times per week	None1234567 times per week
Intervals? (Sprints, Hill rpts., Longer TT Intervals, etc)
Number of Races
Training Availability List the typical hours per day (if any) that you are able to train.
Total Hrs per Week
Mon		Tues
Wed		Thurs
Fri		Sat
Sun
Miscellaneous Information
Do you have other physical or recreational hobbies? Is your work strenuous?
Describe your general health and history of injuries that may affect your ability to train.
What's your favorite cycling workout?
What is your favorite running workout?
Your favorite swimming workout?
Do you own a heart rate monitor?		NoYes	What type?
Do you own a power meter?		NoYes	What type?
Do you have short, steep hills (1-2min in riding time) where you train?		NoYes
Do you have long hills (5+min in riding time) where you train?		NoYes
Do you have an uninterrupted flat section of road 3 miles in length?		NoYes
Do you swim with a group?		NoYes
Do you own an indoor trainer or have access to a treadmill?		NoYes	What type?
Do you own rollers?		NoYes	What type?
Personal Rating Give us an idea of your level in each of the areas below, where 1 is very poor and 10 is excellent.
	Rating	Additional comments
Endurance	012345678910
Speed	012345678910
Power	012345678910
Strength	012345678910
Motivation	012345678910
Pain Tolerance	012345678910
Committment	012345678910
Flexibility	012345678910
Core Strength	012345678910
Recovery	012345678910
Positive Attitude	012345678910
Marketing Research How did you hear about Per4mance Training?
I found P4T:	Per4mance Training Website GoogleYahooMSNOther Internet SearchMedia Advert or CoverageInstore FlyerWord of MouthOther
Other
My Team / Club / Org
I have read and agreed to the waiver.