Philly Surge Running Coaching Questionnaire
Sex *
Address *
Your answer
Age *
Your answer
Date *
Your answer
Full Name *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Health Risks (i.e., family history, chronic disease, high blood pressure, cholesterol, etc.) *
Your answer
Running Injuries in past year? *
Include any ache or pain that cause you to miss 1 or more days of training
Your answer
Personal Bests (List your performances)
Please list race distance, pace/time, and date of race
Your answer
Please List Your Running and Racing Goals *
Your answer
Describe any previous problems with racing or training *
Your answer
What's your #1 reason for joining our club? *
Your answer
How many miles (or hours) of running per week have you averaged in the past 4 weeks?
And what's your typical mileage per week range throughout the year?
Your answer
Additional Comments or Concerns
Your answer
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