Athlete Intake Form Step 1 of 4 25% Your Personal InformationYour Name(Required) First Last Your Email Address(Required) Enter Email Confirm Email Your Phone(Required)Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Social Media UsernamesXInstagramFacebook Personal InformationDate of BirthMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920HeightWeightList any medical conditions or injuries (past & current) Athletic InformationIs there a specific race your are training for? Yes No Name of the Race(Required)Date of the Race(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Any other races leading up to the race you're training for?What percentages of your training do you….?RunSwimBike Add RemoveDo you currently strength train, or plan to begin strength training? Yes No Explain your current strength training or if you plan to begin strength training(Required)Personal BestsList your running personal bestsList your swimming personal bestsList your biking personal bestsRecent RacesList your races within the last year (Road or Trail?)GoalsWhy do you want to run?What do you hope to improve on in running?Do you have any specific race goals? New PR? New distance? Training InformationWhat does your average training week look like? (what days do you train, what type of training…)Any days, or time of day, that is either good or bad for training. Any obligations that need to be taken into account for scheduling?Do you follow any specific nutrition guidelines? (low carb / plant based / vegan / etc.) Please describeHow many days per week could you commit to running?Select One1234567Describe your current training volume for a typical week (miles or hours & activity) – MorningYour morning training volumeMondayTuesdayWednesdayThursdayFridaySaturdaySunday Add RemoveDescribe your current training volume for a typical week (miles or hours & activity) – LunchYour lunch training volumeMondayTuesdayWednesdayThursdayFridaySaturdaySunday Add RemoveDescribe your current training volume for a typical week (miles or hours & activity) – EveningYour evening training volumeMondayTuesdayWednesdayThursdayFridaySaturdaySunday Add RemoveDescribes your total training volumes for the past 4 weeks (miles or hours & activity)Last WeekDatesTotal MilesDays/Week Run Add RemovePrevious Week #3DatesTotal MilesDays/Week Run Add RemovePrevious Week #2DatesTotal MilesDays/Week Run Add RemovePrevious Week #1DatesTotal MilesDays/Week Run Add RemoveCurrent Training VolumeCurrent Training Volume – RunLongest in last 3 monthsLongest Ever Add RemoveCurrent Training Volume – SwimLongest in last 3 monthsLongest Ever Add RemoveCurrent Training Volume – BikeLongest in last 3 monthsLongest Ever Add RemoveEquipment & FacilitiesCheck all that apply to you Track Hills Gym Treadmill Elliptical Pool GPS Watch HR Monitor Comments about equipment or facilities?How did you hear about 4CycleRunner Coaching?What made you decide to select 4CycleRunner Coaching?What made you decide to select 4CycleRunner Coaching?Have you worked with a running coach before?Do you have any expectations you wish to share?
