Personal Information
Name:
Address:
City: Zip:
E-mail:
Phone: Best # to reach you:
Emergency Contact (name): (phone):
I am registering for: Beginner 5k Clinic Intermediate Run Clinic Sport Specific Strength Training for Endurance Athletes
Is this your first TS Clinic or TS Camp? Yes No
If you previously attended a TS Clinic or Camp, please give date(s) and location(s):
Rate your fitness level on a scale of 1-10 (1=poor; 10=excellent):
Referred by (please be specific):
How did you find us?
What is your main goal?
What are your health and fitness goals for the next 3 months?
How much running have you been doing lately?
Are you training for an upcoming race? If so, please list date and event/performance:
How much training have you been doing in the following sports within the last 6 months?
What do you think your timed mile will be?
What is the date of your last physical exam?
Are you allergic to any medicines (aspiring, penicillin, sulfa, etc.)?
List prescribed medicines you take on a permanent or semi-permanent basis:
