Endurance Athlete Questionnaire

Dear Athlete,Congratulations on choosing Greenfield Fitness Systems to design and oversee your training program! This triathlete questionnaire is one of the most important forms you will share with your coach, and will allow thorough development of a personalized training program. Plan on taking 45-60 minutes to complete the form, and do not hesitate to contact your coach if there is additional information you wish to share. After completing, please remember to push the "Submit" button at the bottom of this page. A coach will contact you within 48 hours after completion of this form.
  • The following fields are designed to give your coach an idea of your current and potential training frequency and volume. If your schedule changes from week to week, that's OK. The main focus of this part of the questionnaire is to let your coach know what your current training schedule looks like, and how much potential flexibility you have in your training days/hours. If you feel that you can articulate this information better in an e-mail or phone conversation, let your coach know and then feel free to leave these spaces blank. There will be an opportunity later in the questionnaire to describe your actual workouts.

  • The following questions are designed to give your coach a better idea of how you train and what type of workouts you perform. Be as specific as possible. If you utilize a power meter, heart rate monitor or heart rate training zones, describe your intensities. You can also describe your intensities using a rating of perceived exertion (1=easy, 10=hard) or an adjective (easy, long, hard, fast, short, etc.). Remember to indicate if you currently utilize bricks or combined workouts.

  • The following questions will help your coach determine the equipment and gear you currently use or have access to for training.

  • The following questions are designed to give your coach a clear idea of your training environment and access to areas for swimming, cycling, running, and other activities.

  • The following sections are designed to give your coach an idea of your skill limitations. Please choose the *best possible answer*. Your coach realizes that you may have multiple priorities or limitations, but choose an answer that is most relevant to you. If you would rather describe your limitations in your own words, please write in the space provided.

  • The following questions are designed to help your coach design your racing schedule, familiarize your coach with your desired races, and clearly outline your goals for this racing season. If you have already supplied your coach with a race resume or potential race schedule, you may skip all of this section UNLESS you still need to prioritize your races.

  • YOU’RE ALMOST DONE! The following questions are designed to familiarize your coach with your current nutrition and supplementation practices. Greenfield Fitness Systems specializes in assisting athletes with training, racing, and recovery nutrition from a holistic and healthy lifestyle perspective.

  • FINAL SECTION! Describe what you truly desire from working with a coach. What do you want out of this season? Out of triathlon? Out of life? In other words, why are you sitting here, taking valuable minutes out of your life to complete this form? What are your goals? Be as honest and specific as possible, describing actual races, rankings, or outcomes you want to pursue. You may also use the following section to include any additional general notes for your coach. Include anything that you feel would be helpful that you haven’t yet had a chance to express.

  • Please read the following waiver, then, if you agree to the terms, sign your name.Activity: Any and all prescribed, instructed, implied or suggested activities from Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield (collectively referred to as “The Released Party”), and all volunteers, agents, employees or independent contractors in any way associated with the Released Party, including, but not limited toall multi-sport related physical activities, outdoor endurance running and sprinting, running, jogging, and walking at a moderate to high effort on a grass surface; muscular stretching and flexibility exercises; body weight and calisthenic exercises, including push-ups, sit-ups, squats and lunges; plyometric and jumping activities including straight up and side to side jumping on surface such as rubber, grass, and asphalt; suggested take home exercises; open water swimming (for triathletes and swim lessons), often at depths above head level; weightlifting; rowing; stairclimbing; indoor bicycling; bicycling on and off roads that are open to traffic; dismounting from bicycle; tracking nutritional intake; increasing or decreasing caloric intake; suggested meal plans, menus, or recipes; food supplementation; or any other activity prescribed, instructed or suggested from Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield and not listed in this document.RELEASE OF CLAIMS, ASSUMPTION OF RISK, CONTACT AND WAIVER OF LIABILITYI understand and am aware that this Activity is potentially hazardous. I acknowledge the possibility that injuries and physical and mental changes arising during and/or resulting from engaging in this Activity do exist. These injuries and changes include, but are not limited to, abnormal blood pressure, fainting, disorders in heartbeat, heart attack, joint injuries, and, in some instances, death. I understand Injuries and Changes could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. I am voluntarily participating in this Activity with knowledge of the dangers involved. I understand and take sole responsibility for any and all Injuries and Changes that may occur to myself and/or others, including but not limited to Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield, related to any and all Activities associated with Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield, even if not specifically set forth in this document, whether or not they fall within the scope of reasonably foreseeable injuries related to this Activity, and whether or not undertaken in the presence of staff or physical location of Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield. Although Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield will take precautions to ensure my safety, I expressly assume and accept sole responsibility for my safety and for any and all Injuries and Changes that may occur.
I release Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield and all volunteers, agents, employees or independent contractors in any way associated with the Released Party from any and all liability for any personal injury, death, property damage or loss I may suffer as a result of, arising from, related to or in any way connected to my participation in this Activity, and for any cause whatsoever including negligence, including active negligence, passive negligence or gross negligence on the part of Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield and all volunteers, agents, employees or independent contractors in any way associated with the Released PartyI declare myself physically and mentally sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation in this Activity. I acknowledge I have been informed of the need for a physician’s approval for my participation in an exercise/fitness Activity. I recognize it is my sole responsibility to obtain an examination by a physician prior to involvement in any exercise program. I acknowledge I have either had a physical examination and been given my physician’s permission to participate, or if I have chosen not to obtain a physician’s permission prior to beginning this Activity, I acknowledge I am doing so at my own risk.I understand that if under any circumstances I experience lightheadedness, dizziness, muscular pain, excessive fatigue or any other painful or uncomfortable signs that exceed normal exercise fatigue, I am not obligated to continue this Activity. Furthermore, I may stop this Activity at any time as I desire.Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield’s personal trainers, coaches, and sports nutritionists are not Physicians or Registered Dieticians. They do not diagnose or treat disease. I have been informed that I should consult a Physician before undergoing any dietary or food supplement changes. Any recommendations or suggestions from Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield for changes in my diet, including but not limited to the use of food supplements, food substitutions, caloric intake, meal plans, recipes, and menus are entirely my responsibility, and I release Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield from any and all liability for any illness, personal injury, death, property damage or loss I may suffer as a result of any change in my nutrition, diet, or food intake. I acknowledge and agree no warranties or representations have been made to me regarding the results I will achieve from this program. I understand results are individual and may vary.This Waiver and Release shall be governed by the laws of the State of Washington. All disputes arising from this Waiver and Release Agreement, and participation in any Activity, whether in Contract, Tort or Equity, shall be brought in the State of Washington By signing below, you agreed to subject yourself to the jurisdiction of Washington and thereby waive any argument of lack of personal jurisdiction or forum non conveniens.I acknowledge I have thoroughly read this waiver and release and fully understand it is a waiver and release of liability. By signing this document, I am waiving any right I, or my heirs and/or assigns, may have to bring any and all legal actions or assert any and all claims against Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield, its respective representatives, executors, and/or assigns. I confirm that I have read over this agreement before signing, that I understand it, and that it will be binding not only on me but also on my heirs, my next of kin, my executors, administrators and assigns.I represent and warrant I am signing this agreement freely and willfully and not under fraud or duress. I further represent and warrant no social relationship exists between Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield and me, or if such a social relationship exists, for purposes of my training sessions, Trainer and I have assumed a strict business relationship, and I understand any social relationship does not render this waiver invalid. These exculpatory clauses are intended to apply to any and all activities occurring during the time for which I have contracted with Human Wellness Solutions, Greenfield Fitness Systems or Ben Greenfield.

One Response to “Endurance Athlete Questionnaire”

  1. Nick Laszlo January 12, 2016 at 1:00 pm #

    Hi Ben, thanks again for considering me as a client. Let me know if and when you want me to send you all the data that I mentioned in the questionnaire, i.e. link to Strava and TrainingPeaks, “23andme” results and “DNAfit” nutrition analysis, DEXA, and bloodwork (I’ve had almost everything tested, but not in the past 12 months, so let me know if there’s any new labwork you want me to do, my annual physical is in 2 weeks and I have pretty good insurance). Thanks. I look forward to hearing from you.

    Cheers,

    Nick Laszlo

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