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Name
(Required)
First
Last
Email
(Required)
Primary Discipline(s)
(Required)
How long have you been consistently physically active?
(Required)
How often do you take part in physical exercise?
(Required)
5-7X/Week
3-4X/Week
1-2X/Week
Other
How many times/week do you focus on stretching/mobility?
(Required)
5-7X/Week
3-4X/Week
1-2X/Week
Other
How many times per week do you focus on strength training?
(Required)
5-7X/Week
3-4X/Week
1-2X/Week
Other
Do you have any discipline-specific goals in the next 1-3 years?
(Required)
What are your long-term goals from an exercise and mobility perspective?
(Required)
What is the biggest barrier for you to achieve the above goals?
(Required)
Do you often experience pain, tension, stress knots, and/or limited mobility during daily life?
(Required)
1=Never & No Pain, 10=Always & Very Painful
Do you often feel pain or restricted mobility when exercising?
(Required)
1=Never & No Pain, 10=Always & Very Painful
Where in your body do you feel more restricted in your movements?
(Required)
Please describe any injuries you have had. (include the type of injury, possible cause, date, how long it lasted, etc…)
Agreement to use Thomas Endurance Coaching Inc. Services and Waive Liability
(Required)
I voluntarily choose to participate in the events and services of Thomas Endurance Coaching Inc. in order to improve my fitness, racing, and/or abilities. I understand that the training philosophy of Thomas Endurance Coaching Inc. is to very gradually and scientifically increase my ability to train and race more effectively. I also understand that this training philosophy may create certain potential risks such as abnormalities in my blood pressure, breathing, heart rate, and/or muscular-skeletal system that cannot be predicted with complete accuracy. I understand that I am responsible for monitoring my own condition throughout the event hosted by Thomas Endurance Coaching Inc. which I have chosen and agreed to undertake, and should inform the event leader and/or my primary care physician if any unusual symptoms or conditions occur, I will immediately cease participation and inform the coach and/or my primary care physician of the symptoms or condition. In stating that I agree to this agreement and waiver of liability, I acknowledge that I have read this form in its entirety and that I understand the potential risks associated with these events. I also agree to consult with and obtain written permission from my primary care physician prior to undertaking this bout of training. If I do not consult with and obtain permission from my primary care physician, I accept any and all consequences that may result from this inaction on my part be them injury, discomfort, pain, or any other impact as a result of participation in this event. Finally, in consideration for being allowed to participate and choosing to engage in this program, I agree to assume the risks of such training, and further agree to hold harmless Thomas Endurance Coaching Inc., and/or any coaches, partners, or related staff from any and all claims, suits, losses, and/or related causes of actions and damages, including, but not limited to, such claims that may result from my injury or death, accidental or otherwise, during or arising in any way from, these services.
To agree, please check the box below:
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