Athlete Questionnaire | Full Circle Endurance

NOW ACCEPTING CLIENTS FOR THE 2024 SEASON!

Coaching Services

Athletic Performance Coaching

Para-Athlete Coaching

Pre-Purchase Bike Fit

Endurance Coaching Consultations

Swimming Video Analysis

Running Video Analysis

Camps & Clinics

Full Circle Endurance Crew

Custom-Built Training Plans

Running Custom-Built Training Plans

Cycling Custom-Built Training Plans

Triathlon Custom-Built Training Plans

Duathlon Custom-Built Training Plans

Aquabike Custom-Built Training Plans

Aquathlon Custom-Built Training Plans

Marathon Training Plans

Half Marathon Training Plans

5K Training Plans

Sprint Triathlon Training Plans

Half Distance Triathlon Training Plans

Full Distance Triathlon Training Plans

Custom-Built Training Plans

Custom-Built Training Plans

About Us Meet Coach Laura Testimonials

Educational Events & Clinics Blog Podcast Newsletter

Athlete
Questionnaire

This Questionnaire is for athletes who are hiring Full Circle Endurance and serves as the contract for coaching services.
‍Thank you for telling us more about yourself before we get started working together!

First NameLast NameEmail AddressWhat type of service/coaching are you interested in?Performance Coaching (Customized, Continuous One-On-One Coaching)Custom-Built Training PlanBike FittingEndurance Sports ConsultationSwimming Video AnalysisRunning Video AnalysisMentoringOccupation/Hours Per WeekFrom whom did you hear about us?

WebsiteSearch Engine/Google

Social MediaCamp/Clinic

Another Full Circle Endurance AthleteOther (Please specify below)

Referring Athlete's Name / Camp or Clinic / OtherMailing Address (Include Street/Location, City, State, and Zip Code)Date of BirthPhone Number (Including Area Code)USA Triathlon Annual Membership Number (Enter N/A if you are not one)USA Triathlon Annual Membership Number (Enter N/A if you are not one)Male (including transgender men)Female (including transgender women)Prefer to self-describe as ____________ (non-binary, gender-fluid, agender; please specify)Prefer not to sayGender Self-Description (If Applicable)WeightHeightCurrent MedicationsAllergiesDietary Preferences/Restrictions

VegetarianVegan

KosherHalal

Gluten-freeNone

OtherDo you have, or have you ever had, any of the following? (Check all that apply.)Heart DiseaseCancer (If yes, please specify type, date of diagnosis, and current status in "Other" below)Heart Surgery
Heart AttackHeart MurmurHypertensionAsthmaDiabetesAnemiaThyroid ProblemsWheezingEpilepsyStress fractureEating DisorderOther (Please Specify Below)Please explain any of the boxes that you checked in the above question.Check any of the following statements that are true.A doctor has said that I have a heart condition that should limit my physical activity.I have had chest pain brought on by physical activity.I have developed chest pain within the last month.I tend to lose consciousness or fall over as a result of dizziness.A doctor has recommended medication for high blood pressure or a heart condition.I am aware of other physical reasons that I should not exercise without medical supervision.None of the above apply to me.Please explain any of the boxes that you checked in the above question.Please check any of the questions if your answer is 'Yes'.Do you have any metabolic diseases, controlled or uncontrolled, such as diabetes, hyperthyroidism, hypothyroidism, etc.?Do you, or have you ever, smoked regularly?Do you have high cholesterol?Have you had any surgery in the last year?Have you ever had an injury that caused you to stop exercising for more than one month?Are you, or have you ever been, anorexic or bulimic?Are there any other physical or emotional problems that may affect your training?None of the above.Please list any current illness, recent injuries, recent surgeries, or past medical problems or surgery of note that were not covered in the preceding questions:What fitness equipment do you have access to? (Check all that apply.)

Training GymTRX (or other Suspension Training System)

GPS Fitness Wearable (Garmin, Polar, Coros, etc.)Treadmill

Running Power MeterRoad Bike

Mountain BikeTriathlon Bike

Other BikeBike Power Meter

Indoor Classic Bike TrainerIndoor Smart Bike Trainer

ZwiftRouvy

TrainerRoadBike Computer

Lap Swimming PoolOpen Water Swimming Access

OtherDescribe your athletic historyDescribe your training in the last three weeks.How many hours do you have to train during weekdays and weekend days?What are your most important goals for this season?What are your expectations of Full Circle Endurance?At the end of this season, how will you judge if the training program was successful?This is your contract for coaching services with Full Circle Endurance. Type your name below the following statement to represent your digital signature declaring that you have read and agree to the statement.Contract for Payment of Services/Zero Tolerance Anti-Doping Policy
I hereby contract Full Circle Endurance, LLC as my personal coach for endurance sports. I agree to pay for my selected services on either a monthly basis at the beginning of the month for a minimum of three months or for a one-time rate at the time of service depending on the type of service selected. I am enrolling to be part of the Full Circle Endurance USA Triathlon Certified Club and understand that my club dues are included as part of my coaching service fees.

I understand that there shall be no refund or proration of any fees covering the first 90 days of participation, regardless of the reason, whether health/sickness/injury/financial/job termination/geographic relocation/divorce/separation/etc., is the cause for dropping out. After such initial 90 day period, any refund or proration of fees for any subsequent period of time for any reason shall be at the sole discretion of the management. Fourteen (14) calendar days’ written notice is required to terminate any services. In the event of non-payment, I understand that I am responsible for all reasonable collection costs, which will be added to any fees for coaching services that are unpaid.

I understand that Full Circle Endurance, LLC has a zero-tolerance policy for doping. This is defined as an athlete taking illegal, prohibited substances listed in the World Anti Doping Agency (WADA) Prohibited List. Depending on the race event, either United States Anti-Doping Agency (USADA) (USA Triathlon sanctioned events, for example) or WADA rules apply.

If an athlete is known to have taken a Prohibited Substance by any coaching staff at Full Circle Endurance, LLC or has tested positive by any national or international drug testing organization during training, competition, or both, he/she will no longer be a Full Circle Endurance, LLC athlete.

I understand that it is my responsibility to know what is prohibited and what I ingest in my own body. I fully support clean sport and understand Full Circle Endurance, LLC’s zero-tolerance policy. In the event of any dispute of any terms contained in this agreement, the parties agree that any such dispute shall be governed by the laws of the State of New York.I AGREE WIth ALL TERMS AND CONDITIONS SET FORTH IN THE ABOVE STATEMENTType your name below the following statement to represent your digital signature declaring that you have read and agree to the statement.In consideration for being accepted as a client by Full Circle Endurance, LLC for the purposes of improving my fitness, I hereby attest that I am in good health, that my statements in the Athlete Questionnaire are accurate to the best of my knowledge, that my physical condition has been verified by a licensed medical doctor, and that I have medical insurance that will cover any/all doctor or hospital costs, subject to any deductibles for which I will be responsible, in the unlikely event that I sustain a training-related injury.

I fully understand the various risks inherent in such a fitness program and accept for myself, my heirs, and my personal representatives, full responsibility for personal bodily injury, death, or property losses, including lost wages, lost income, and any impairment of income-earning capability that may occur as a result of my being a part of this program or engaging in training sessions.

I hereby indemnify and save and hold harmless Laura Henry and any other contracted coaches working under Full Circle Endurance, LLC from any loss, liability, damage, and cost I may incur due to my participation in this program. I have read and am voluntarily signing the waiver and release from liability, and further agree that no oral representations, statements, or inducements apart from the forgoing written agreement have been made.

I hereby grant full permission to Full Circle Endurance, LLC to use any photographs, videotapes, motion pictures, web images, records or any other record of this service to be enrolled to receive the company newsletter. In the event of any dispute of any terms contained in this agreement, the parties agree that any such dispute shall be governed by the laws of the State of New York.I AGREE WIth ALL TERMS AND CONDITIONS SET FORTH IN THE ABOVE STATEMENTToday's Date

Thank you! Your Athlete Questionnaire has been received!

Oops! Something went wrong while submitting the form.

About Us

Who We Are Events/Clinics Blog

Services

Home Coaching Services Training Plans

HOURS

M/W/TH/FR - 1000-1800

TU/SA/SU - CLOSED

Contact Us

Laura@FullCircleEndurance.com

Start Your Training

Start Your Training

Start Your Training

Services

Home Coaching Services Training Plans

About Us

Who We Are Events/Clinics Blog

HOURS

M/W/TH/FR - 1000-1800

TU/SA/SU - CLOSED

Contact Us

Laura@FullCircleEndurance.com

© 2016-2024 Full Circle Endurance, LLC

Website designed by VisualTide