Triathlete Questionnaire

TRIATHLETE QUESTIONNAIRE

(ALL INFORMATION IS HELD IN CONFIDENCE)

Name:

______

Date of Birth: ______Current Age: ____ Sex: M F T-Shirt Size ______

Height:_____ Weight:______Married:_____ If So, How Long:______

Home Phone:______Work:______

Cell:______Text message?____ Do you have DSL (fast internet)_____

Mailing address:

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Can you learn to do elementary things on an Excel Spreadsheet?______

Email address:

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Yourealizetriathlon, by its very nature, requirestime and dedication. Do you anticipatethatcausing stress with your family?______

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Ages of Children:______

What are your normal work hours?______

What does your job/vocation involve?

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Describe your history in swimming, cycling, and running. How would you rank order your enjoyment of these 3 events? Do you have significant concerns or fears about either?

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How many hours per week do you swim, bike, and run? Specify time for each. ______

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How many years have you been training at least 4 hours per week? Describe that training.

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When during the day do you usually train?______

What do you enjoy most, speedor distance training?

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What do you expect from your coach?______

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What is your resting heart rate? ______

(One method is to check your pulse rate immediately after awakening and before you get

out of bed. Do this for three days and take the average.)

Do you have access to a track?______

Are you willing to do speed work on a track?______

Do you own a heart-rate monitor?______Do you use it? ______

Are you willing to purchase a heart rate monitor if you do not have one? They can range from $40 up. ______

Do you run with a GPS unit?______

Do you currently do any “Speed work”?______Describe:______

______

Do you have access to a pool?______

Do you have access to a treadmill?______

Do you have a bike? If so mountain or road bike? ______

Do you have access to a stationary bike?______

Do you do any strength training?______

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Have you ever run a triathlon? ______

If so, what distances and how many:

Sprint______Olympic_____Half Ironman_____Ironman_____

Do you subscribe to any triathlon, cycling, or running magazines?

______

Are you willing to keep your mileage on a chart that can be emailed to me? ______

Are you willing to communicate via email? ______

Are you willing to respond to email within 1 day? ______

Are you willing to email your past week’s training accomplishments within a day of completion? ______

If you are over 40, does your doctorknow of your running plans? ______

Do you have high blood pressure? ______

Have you ever had any heart problems? ______

Are you more than 10 pounds overweight? ______

Please report on previous recent injuries (within the last 18 months)

______

Do you know that triathlon:

Requires a great commitment ______

Can be dangerous ______

Requires great patience______

Can create over-use injuries______

I am particularly sensitive to two safety issues. Please answer the following questions:

Cycling requires constant awareness of those you are riding with and automobiles.

It is impossible to maintain this awareness with headphones/ear buds in

and listening to music. Will you agree to never do this while cycling?

______

A cramp or fatigue running or cycling has an easy solution. Stop. If swimming

without a partner in the open water (e.g. lake, ocean) though you are left

with a very unsafe lack of options. Will you agree to never swim by

yourself in the open water?

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There are lots of reasons why people want to participate in triathlon. Please share with me your reasons.

______

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IMPORTANT: I need to know what GOALS you wish to accomplish, and if there are timetables you wish to meet to accomplish these goals. ______

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YOU REALIZE THAT I’M NOT AN EXPERT AND NOT A DOCTOR AND THAT YOU MUST, AS A RESPONSIBLE ADULT, DECIDE WHETHER TO FOLLOW MY SUGGESTIONS, AND THAT YOU, NOR YOUR KIN, WILL HOLD ME LIABLE FOR THESE SUGGESTIONS

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THE FORM ABOVE CAN BE RETURNED VIA EMAIL OR U.S. MAIL: Roger A Weldon, 1280 Wemple Road, Bossier City, LA 71111

THE FORMS BELOW MUST HAVE SIGNATURE AND CANNOT BE EMAILED.

Participation and Assumption of Risk Agreement

Athlete’s Name______Age ______

______“Athlete”, in consideration of being permitted to participate in the athletic, running and conditioning training program with Roger A Weldon & Team26pt2, acknowledges that participation in such a training program can be hazardous to my health and that I have an increased risk of injury by participating in this program.

I agree and understand that I am solely responsible for my health and medical condition, and that it is my sole responsibility to determine my physical and medical fitness to undertake a strenuous training program. I acknowledge that Roger A Weldon & Team 26pt2 is not a medical doctor and that advice and recommendations of Roger A Weldon & Team 26pt2 are based upon Roger A Weldon & Team 26pt2’s training and experience as a triathlete.

I know that triathlon is a potentially hazardous activity and certify that I am in good health and physically fit to enter into a training program. I acknowledge that I am aware of the many risks involved in athletic training in general and running training specifically, which risks include by way of example and not limitation: 1) minor injuries such as scrapes, bruises, sprains and strains, 2) more serious injuries such as joint, muscle and bone injuries, concussions and other head injuries, heat related injuries such as heat stroke and heat exhaustion, dehydration and over hydration conditions such as hyponatremia, catastrophic injuries and conditions such as heart attacks and other conditions or injuries which could be fatal.

I accept all the inherent risks of participating in the triathlon and conditioning training program. I understand and agree that Roger A Weldon & Team 26pt2 shall assume no responsibility or liability for me for accident, illness, or loss of, or damage to, personal property resulting from participation in this Training Program.

The forgoing is submitted in consideration of Roger A Weldon & Team 26pt2 allowing my participation in this Training Program. I confirm that I am of adult age and I execute this document with full knowledge of the contents and consequences stated in this Agreement.

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Signature of AthleteDate

Athlete’s Name ______Age ______

Waiver of Liability, Assumption of Risk, and Indemnity Agreement

Waiver: In consideration of being permitted to participate in Roger A Weldon & Team 26pt2Training Program I, for myself, my heirs, personal representative and assigns, do hereby release, waive, covenant not to sue and discharge Roger A Weldon & Team 26pt2 from liability from any and all claims including the negligence of Roger A Weldon & Team 26pt2 resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in Roger A Weldon & Team 26pt 2 Training Program.

______

SignatureDate

Assumption of Risks: Participation in triathlon and conditioning programs carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. I know that triathlon is a potentially hazardous activity and certify that I am in good health and physically fit to enter into a training program. I acknowledge that I am aware of the many risks involved in athletic training in general and triathlon training specifically, which risks include by way of example and not limitation: 1) minor injuries such as scrapes, bruises, sprains and strains, 2) more serious injuries such as joint, muscle and bone injuries, concussions and other head injuries, heat related injuries such as heat stroke and heat exhaustion, dehydration and over hydration conditions such as hyponatremia, and catastrophic injuries and conditions such as heart attacks and other conditions or injuries which could be fatal. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in training for and participating in triathlon training and racing and any conditioning and cross training activities associated with that training. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. ______(Initial)

Indemnification and Hold Harmless:I also agree to INDEMNIFY AND HOLD HARMLESS Roger A Weldon & Team 26pt2 from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in Roger A Weldon & Team 26pt2’s Training Program. ______(Initial)

Severability: The undersigned further expressly agrees that the forgoing waiver and assumption of risks agreement is intended to be a broad and inclusive as is permitted by the law of the State of Tennessee and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement consisting of two pages, fully understand its terms, and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

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SignatureDate

Athlete must sign and return the Participation and Assumption of Risk Agreement and the Waiver of Liability, Assumption of Risk, and Indemnity Agreement to Roger A Weldon, 1280 Wemple Road, Bossier City, LA 71111. Forms must be sent by U.S. Mail.

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