Let’s get started Tell us more about your goals, fitness, and lifestyle. We look forward to working with you. Full name * First Name Last Name Birth Date * MM DD YYYY Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Country (###) ### #### What is your preferred communication method? * Email Text Emergency contact * First Name Last Name Phone number * Country (###) ### #### Athlete information - Training questions * How do you rate your desire and determination to achieve this goal? 10= Extremely High; 1 = Non-existent 1 2 3 4 5 6 7 8 9 10 What is the biggest challenge that your next mountaineering objective will present? * How do you define success on your next mountaineering objective? * What exercises and activities do you enjoy? * E.g.: running, rock climbing, yoga, squats, pull-ups What exercises and activities do you LEAST enjoy? * What is your training environment? * Gym, mountains, stairs, beach What day of the week do you prefer to have off from training * If you don't have a preference, Mondays are recommended so you can have a break from long weekend training sessions. Sunday Monday Tuesday Wednesday Thursday Friday Saturday How many years have you been climbing / mountaineering * What do you consider your strengths? * What do you consider your weaknesses? * What aspects of climbing / mountaineering do you want coaching? * What are your long term climbing / mountaineering goals? * Long term = as far in the future as you are willing to plan Please rate yourself on the following: * General Fitness 1 Worst 2 3 4 5 6 7 8 9 10 Best Speed 1 Worst 2 3 4 5 6 7 8 9 10 Best General Strength 1 Worst 2 3 4 5 6 7 8 9 10 Best Core Strength 1 Worst 2 3 4 5 6 7 8 9 10 Best Endurance 1 Worst 2 3 4 5 6 7 8 9 10 Best Flexibility 1 Worst 2 3 4 5 6 7 8 9 10 Best Recovery 1 Worst 2 3 4 5 6 7 8 9 10 Best Dedication 1 Worst 2 3 4 5 6 7 8 9 10 Best Communication 1 Worst 2 3 4 5 6 7 8 9 10 Best Competitive Drive 1 Worst 2 3 4 5 6 7 8 9 10 Best How do you rate your current nutrition * 10= Well balanced and healthy; 1 = Horrible 1 2 3 4 5 6 7 8 9 10 Describe what you typically eat and drink in a day * What are your typical work hours? * Describe your current weekend commitments * Do you participate in any other sport, recreation or fitness activities? * If yes, please include level and weekly time commitment. What do you want to get out of our athlete / coach relationship? * Athlete information - Health questionnaire * Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO. Health Questionnaire Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? Yes No Do you feel pain in your chest when you do physical activity? * Yes No In the past month, have you had chest pain when you were not doing physical activity? * Yes No Do you lose balance because of dizziness or do you ever lose consciousness? * Yes No Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity? * Yes No Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition? * Yes No Do you know of any other reason why you should not do physical activity? * Yes No Do you have any other injuries? * I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction. * Athlete information - Liability waiver * I am aware of the risks in observing or participating in the activities offered and sponsored by Alpine Athletics and I understand that all sports or fitness that I will execute and participate in are entirely at my own risk and perils. I assume complete responsibility and liability for those risks and for the injuries that may occur as a result of these risks, even if injuries occur in a manner that is not foreseeable at the time I sign this agreement. I realize that by voluntarily assuming the risks involved, I will be solely responsible for any loss or damage I sustain, including personal injuries to me, damage to my property, or damage arising out of my death. It is understood that Alpine Athletics is responsible for any damage that would be resulting from a fault of Alpine Athletics and its representatives. Signature * Date * MM DD YYYY Thank you!
