RUN717 Questionnaire
This form provides the coach with background information.
Email address *
First and Last Name
Your answer
Phone Number, with area code
Your answer
Age and Gender
Your answer
City and State (or Country if applicable)
Your answer
What is your goal? (Get fit? Run a 5k? Run a marathon? Train for a specific race? Include Time Goal, if known)
Your answer
Do you have any limitations? (Physical limitations, disabilities, injuries)
Your answer
Describe your running history. How long have you been running? Are you new to running? Did you run in school and are a returning runner? Or have you been running for a while and now you're ready to crush a new goal?
Your answer
Running Mileage ONE Week ago *VERY Important: Number of Days you ran LAST week, your Total Mileage, and your Longest Run last week. Example;Week 1: Runs=3, Total=8 miles, Longest Run=3 miles (last week)
Your answer
Running Mileage TWO Weeks ago *VERY Important: Number of Days you ran TWO weeks ago, your Total Mileage, and your Longest Run that week. Example;Week 2: Runs=3, Total=11, Longest Run=4
Your answer
Running Mileage THREE Weeks ago *VERY Important: Number of Days you ran THREE WEEKS ago, your Total Mileage, and your Longest Run that week. Example;Week 3: Runs=0, Total= none, on vacation
Your answer
When are you able to run? 1) What days can you run (and not run)? 2) What day can you do "long runs"? 3) What day(s) would you want for "rest days"? Example: Monday: I have 1 hour to run in the evening, Tuesday: I do Yoga or go to the Gym, Wednesday: I can run 1 hour in morning or evening, Thursday: Kids play ball but I could run while they play, Friday: I must have this DAY OFF, Saturday: This would be best for my "LONG RUN DAY".Sunday: I can run before church at 9 am or after 2 pm
Your answer
Please list any races you have completed this past year. Include distance and your finish time.
Your answer
What do you do for recovery?
Your answer
How did you hear about RUN717 Coaching Services?
Your answer
How else can I help you improve?
Your answer
I know that running is a potentially hazardous activity. I should not run unless I am medically able and properly trained. I assume all risks associated with running, including, but not limited to, falls, contact with other individuals, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my payment, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, waive and release any and all coaches, their representatives and successors, from all claims or liability for death, personal injury, or property damage of any kind or nature whatsoever arising out of, or in the course of, my participating whether same be caused by negligence or fault. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. *
Please electronically sign waiver below.
Your answer
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