JHPS - Training and Coaching Form

First Name		Last Name
Address		City
State		Zip
Phone (h)		Phone (w)
Fax		Email

How did you hear about John Howard Performance Sports Coaching?

Married/Attached? Single? Number of Children

Height Feet Inches Weight Lbs

Birthdate month day year

Occupation Job Description

Health Related Issues (Please be specific)

Average hours of sleep per night

Goal Race (only one!)

Other Short Term and Long Term Goals

List any noteworthy accomplishments in cycling career thus far

Athletic Background

How long have you been cycling?

% Road % Off-Road % Indoor

Spin Class: Hours per week

How many days per week do you ride?

Approximate weekly mileage? Approximate Hours per week?

Do you own a stationary trainer? Trainer Type

How would you describe your cycling focus:

Recreational: Low key Recreational: Serious Recreational:

Road Racing: Criterium: Track: Triathlete: BMX: MTB:DH: XC:

List other activities:

Type of bike(s) and brand(s)?

Do you use a bike computer? yes no

What type of power measurement equipment do you own?

(i.e. Computrainer, Power-Tap, SRM, Polar S710, etc.)

Does your bike computer measure RPM ? yes no

Do you own a heart rate monitor? yes no

Do you own a computer interface for your monitor? yes no

Have you been professionally fit? yes no

If yes, by Whom?

Are you currently following a training program? yes no

Description of current training program, cycling, triathlon etc.:

Do you belong to a cycling club? triathlon club?

List any time trial results and corresponding distance:

Longest ride distance:

Have you had a recent A.T. test done?

Perceived Max HR: When

Have you had a VO2 Max Test?:

VO2 ml/kg: When:

Please list a sample of your training availability in the AM and PM:

Monday		Tuesday
Wednesday		Thursday
Friday		Saturday
Sunday

Do you train regularly with any club or organization? When?

Any additional comments?

After we review your questionnaire, you will be contacted to discuss starting your training program.

AGREEMENT:
This agreement will serve to confirm the conditions and terms of the athlete-coaching agreement between John Howard Performance Sports and You (the athlete) for the duration of your participation in the John Howard Performance Sports Training Program. I (the athlete) understand that this program is copyrighted and is exclusively for my own use. Furthermore, I will NOT reprint, distribute, sell, or otherwise share the materials contained in the John Howard Performance Sports Training Program without permission.

Please understand that the John Howard Performance Sports makes no guarantees or warranties as to the effectiveness or success of its coaching and training program or advice provided as part of such programs. Responsibility for training and racing, and success therein, rests with the athlete. Injury while training is a common occurrence. John Howard recommends you consult a physician or health care professional prior to the start of this or any physical training program. I (the athlete) understand and assume the risks from athletic training and endeavors. I further hold the John Howard Performance Sports, it's officers, employees and agents harmless from any and all claims, actions and damages which may arise either directly or indirectly from any John Howard Performance Sports program or service.

If, during a training session, you feel sick or disoriented or experience chest pains or abnormal discomfort of any sort, stop the training session. If symptoms continue, consult your regular health care professional. If you feel, at any time, that the training program provided is beyond your capabilities or you do not understand the training program, contact the John Howard Performance Sports before attempting any particular workout.

I affirm that I am eighteen (18) years of age or older. I have read the above letter and understand and agree to the terms, conditions and advise set forth herein.