Personal Data Worksheet

Your Name (required):

Your Email (required):

Phone:
Work Phone:

Height: feet inches Weight:
Birth date:
Occupation:
Do you have any health related problems? If so, please mention below:

Race Schedule

Please list below your “A” Race(s):

Please list below additional scheduled Races:

Athletic Background

Swimming
Number of times you currently swim per week:
Do you have access to open water for swimming?:  Yes No
Do you belong to a Masters Swim program?:  Yes No
Average pace for 100 m or yd:

Cycling
Current Avg Weekly Mileage: miles per week
Do you own an indoor training device?  Yes No
If so, what type?
Do you own a wattage measurement device? (e.g. Powertap, etc.)
 Yes No
Does your bike computer have a cadence feature?
 Yes No
Do you belong to a cycling club?
 Yes No

Running
How often do you run? times per week
Current Avg Weekly Mileage: miles per week
Average longest run each week: miles
Do you belong to a running club?
 Yes No

Other Information
Do you own a heart rate monitor?  Yes No
Does your HRM interface with your PC?  Yes No

Results

Cycling
Pertinent Cycling Results:

Running PRs
What is your 5k PR?
What is your 10k PR?
What is your Half Marathon PR?
What is your Marathon PR?
Additional Pertinent Running Results:

Triathlon
What is your Olympic PR?
Please provide Name, Location, Date, Distances and Splits as available:

What is your 70.3 (Half IM) PR?
Please provide Name, Location, Date, Distances and Splits as available:

What is your 140.6 (Ironman) PR?
Please provide Name, Location, Date, Distances and Splits as available:

Lifestyle

Provide the number of hours available to train each day
Monday: Tuesday: Wednesday:
Thursday: Friday:
Saturday: Sunday:
Please add any additional thoughts you may have for your coach:

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