tripower.org - the home of affordable coaching in multisport
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General Background
First Name: Last Name:
Address:
City: State: Zip:
Phone (h): Phone (w):
Fax: Email:
Married or Otherwise Attached? or Single?
Number of Children:
Height: feet inches Weight:
lbs.
Birthdate:
year month day
Occupation:
Brief Job Description:
Any Health Related Problems?
Average hours of sleep per night:
Goals
Current Season Goal Race (only one!)
Other Current Season Races:
Last Season Races:
Athletic Background

Swimming:

When did you start swimming?
Where do you swim?
Distance to pool from home or work:
How often do you swim?
How many yards/meters do you swim each week?
Do you belong to a Master's swim program? yes no
Best recent 800 time:(indicate meters or yards)
Best recent 1500 time:(indicate meters or yards)
Best recent 2.4 mile time:
Do you have access to: Pull bouy: Paddles: Kickboard: Zoomers/Fins:


Cycling:

When did you start cycling?
Where do you ride?
How often do you ride?
How far do you ride each week?
Do you own a windtrainer/Computrainer?
Do you own a powermeter?
Does your bike computer have a cadence feature? yes no
Do you belong to a cycling club?
What bike(s) do you own?
Best recent 40km/25mile time:
Best recent other times:
Brief description of available cycling routes (distance, terrain, distance from home):

Running:

When did you start running?
Where do you run?
Do you belong to a running club?
How often do you run?
How far do you run each week?
Best recent 5km time:
Best recent 10km time:
Half-marathon time:
Marathon time:
Brief description of available running routes (distance, terrain, distance from home):
General Training
Do you own a heart rate monitor? yes no
Do you own a computer interface for your monitor? yes no
Have you had a recent A.T. test done?  
Cycling results:
Running results:
What is your best recent Olympic Distance time?
What is your best recent half Ironman time?
What is your best recent Ironman time?

What is your typical available time to train per day.

Example:

        Monday: 8am-10am; 5pm-7pm:

        Tuesday: 2hrs, anytime

Monday: Tuesday
Wednesday: Thursday:
Friday: Saturday:
Sunday:    

Please describe your current typical training week:

Do you have specific group training that you attend? If yes, what day/time and in what sport.

Any additional comments you would like to add?

How did you hear about TriPower?


I acknowledge that training for and/or participating in a triathlon, duathlon, cycling, swimming, running or any other endurance sporting event is an extreme test of my physical and mental limits and that such training and/or participation poses potential risks of serious bodily injury, death, or property damage. I have provided Mike Plumb with all information which in any way relates to or that could affect my physical health and attest that I am in good health and my physical condition has been verified by a licensed medical doctor.


Furthermore, in return for my participation in this program, I on behalf of myself and my heirs or executors I hereby:


a) WAIVE, RELEASE, and DISCHARGE Mike Plumb, his officers, directors, administrators, employees, consultants, coaches and agents from any claims, costs or liabilities for personal injury, illness, death or damages of any kind which I may have now, or at any time in the future, resulting from participation in this or any other program;


b) AGREE NOT TO SUE any of the persons or entities mentioned above for any claims, costs or liabilities that I have waived, released or discharged herein;


c) INDEMNIFY, DEFEND, and HOLD HARMLESS the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions.


Submission of this form is agreement to the above terms.

Initialize here to indicate that you have read and agree to the terms above.