
NEW CLIENT QUESTIONNAIRE
Liz Blatchford | Coaching
EMERGENCY CONTACT INFORMATION
ATHLETIC HISTORY
CURRENT SCHEDULE
Please list your realistic available training time below:
CURRENT FITNESS
RUNNING PERSONAL BESTS (PB's)
List your personal bests. If you don't have the time, date and/or HR data- please just provide what information you do have.
CYCLING PERSONAL BESTS (PB's)
List your personal bests. If you don't have the time, date and/or HR data- please just provide what information you do have.
SWIMMING PERSONAL BESTS (PB's)
List your personal bests. If you don't have the time, date and/or HR data - please just provide what information you do have.
DIET AND NUTRITION
TRAINING TERRAIN
GOALS
MEDICAL
GENERAL STATEMENT OF PROGRAM OBJECTIVES AND PURPOSES
I understand that this physical fitness program includes exercises to build the cardiorespiratory system (heart and lungs), the musculoskeletal system (muscle endurance and strength, and flexibility) to try and improve at the athletes chosen sport.
Exercise programming will include gentle aerobic training, high intensity training and strength exercises. All exercises incur some level of risk inherit to the training itself and external factors such as cars, marine life and much more. By signing below, you acknowledge the risks and agree to not hold Transition Fitness (RPG Coaching) responsible for any incidents that occur.
Description of Potential Risks:
I understand that the reaction of the heart, lung, and blood vessel system to exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during or following exercise which may include abnormalities of blood pressure or heart attacks. Use of the weight lifting equipment, and engaging in heavy body calisthenics may lead to musculoskeletal strains, pain and injury if adequate warm-up, gradual progression, and safety procedures are not followed. I understand that the coach or Transition Fitness/ RPG Coaching shall not be liable for any damages arising from personal injuries sustained by client while and during the personal training/coaching program. The athlete/client using the exercising as prescribed by the coach does so at his/her own risk. The client assumes full responsibility for any injuries or damages which may occur during the training.
I hereby fully and forever release and discharge RPG Coaching / Transition Fitness and Health, its assigns and agents from all claims, demands, damages, rights of action, present and future therein.
I understand and warrant, release and agree that I am in good physical condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, or comfort, or physical condition if I engage or participate.
I state that I have had a recent physical checkup and have my personal physician's permission to engage in aerobic, anaerobic and strength and conditioning exercises.
Description of Potential Benefits:
I understand that a program of regular exercise, has many benefits associated with it. These may include an increase in athletic performance, decrease in body fat, improvement in blood fats and blood pressure, improvement in physiological function, and decrease in heart disease. I have read the foregoing information and understand it. Any questions which may have occurred to me have been answered to my satisfaction.
Coaching Fees:
The agreed weekly rate is to be paid via a debit system that is controlled by you the client. By signing below you agree to the payment terms agreed upon with the coach. A coaching fee change will only be made after consultation with clients/athletes with a minimum of 6 weeks notice before the change.
Declaration to abide by WADA/ASADA rules.
By ticking the box below I’m declaring that I will abide by the rules outlined by ASADA / WADA. Should I, the athlete be found in breach of the rules, should it be necessary and requested by Tim Reed or other staff of RPG, I will publicly declare Tim Reed and RPG staff were unaware of your choices to breach the WADA rules.