TRIATHLETE COACHING INFORMED CONSENT AND AGREEMENT
The undersigned hereby voluntarily consents to engage in a program of triathlon
coaching designed to improve your fitness level and triathlon race performance.
Upon completion of the Athletic Profile and Health Assessment Questionnaire, a
customized triathlon training program will be designed for you. During your training
sessions, it is advised to monitor your heart rate and perceived level of exertion. You are
encouraged to keep your coach informed of your fitness progression. Heart rate and
perceived level of exertion are two ways to do so.
Your coach will provide a daily, detailed training program that you are asked to follow.
The program will direct you on exactly what type of training and intensity level to engage
in. Each workout has been designed specifically with you in mind and is based upon
several factors including self-reported current level of fitness, athletic weaknesses and
strengths, and your triathlon goals.
The training program is designed to maximize your potential for improvement with the
minimal amount of training required. You can expect to see gradual, steady
improvement in your fitness as you progress through the training. It is imperative that
you try to follow the program as designed and not to rush your fitness. Specific key
workouts will be indicated as well as days of reduced training/rest that should be
followed to reap the greatest benefits.
As part of the coaching program, you are entitled to no less than a 20-minute phone
consultation and progress review biweekly (26 times per year). Phone consultations are
encouraged on atleast a weekly basis, or more often if needed, during the initial 6 weeks
of training. It is the athlete’s responsibility to call the coach. The coach will return calls
as soon as possible if not immediately available.
There is a minimum three- month coaching commitment payable prior to initiating
training. Subsequently, the athlete can pay month-to-month or recommit for
an additional three-month coaching program . Long term (6 to 12 month) programsare also available. Fees for Coaching are not refundable, but may be stoped due to injury or other unforseen circumstances and restarted once you are healthy and able to train again. Call for details. Please keep track of your payment schedule (every 4 weeks) as to not cause an interuption in your training.
You may eith pay by credit card online or mail a chech to the following address:
Richard Nixon
4960 N.W. 54th Street
Coconut Creek, FL 33073
(954)242-0163
The athlete is encouraged to utilize the expertise of the coach and when satisfied with the
program, refer athletes to Fit 2 Tri Multisport Inc.
As with virtually any athletic activity, there exists a certain risk of injury. The
undersigned acknowledges this risk and agrees that his/her physical condition is adequate
to safely train for triathlon. The undersigned further agrees that if during training an
activity causes pain, you are to stop immediately. However, when participating in any
training program, it is important to distinguish between normal muscular discomfort due
to fatigue, and real musculoskeletal pain that precedes an injury.
Any and all questions concerning training principals and coaching philosophy are
encouraged. You can help the coach do a better job for you by keeping him informed and
through timely communication with him.
I have read the above and agree to follow the same.
Athlete’s Name (please print) _______________________________________________
Athlete’s Signature _______________________________________________
Athlete’s Address _______________________________________________
Street _________________________________________________________
City ___________________________________________________________
State _____________________
Zip _____________________
Phone # ( ) -
Health Screening
HEALTH SCREENING PHYSICAL TRAINING QUESTIONNIARE
Common sense is your best guide in answering the below questions. Please check
YES
or
NO opposite the question.
YES NO
( ) ( ) 1. Has your doctor ever told you that you have heart or lung problems?
( ) ( ) 2. Have you ever had any heart related problems?
( ) ( ) 3. Do you frequently feel faint or have spells of dizziness?
( ) ( ) 4. Do you frequently feel any chest discomfort or pain?
( ) ( ) 5. Has your doctor ever told you that you have a high blood pressure, or have you ever had
high blood pressure in the past, or are you presently taking medications for high blood
pressure?
( ) ( ) 6. Are you aware of any bone, back, or joint problems that may be or could be aggravated
by exercise (e.g. arthritis)?
( ) ( ) 7. Have you ever had an episode of exercise induced asthma, i.e., severe wheezing,
coughing or severe shortness of breath at rest or with mild exertion?
( ) ( ) 8. Do you ever have episodes of labored difficult breathing during the night where you
have to sit up to breath?
( ) ( ) 9. Have you ever been told by your doctor that you have diabetes?
( ) ( ) 10. Are you over age 40 and not involved in regular exercise?
( ) ( ) 11. Is there any good reason not mentioned here why you should not engage in a systematic
exercise training program?
( ) ( ) 12. Are you pregnant?
Date of Birth _________ Age ________
Comments:
_____________________________________________________________
_____________________________________________________________
I hereby certify that the above information is correct.
___________________________ _________________________________________________
Participant’s Name (print) Address City St Zip Code Phone #
____________________________ _____________
Participant’s Signature Date
ANY "YES " RESPONSE CONCERNING CARDIOVASCULAR, PULMUNARY, OR METABOLIC
PROBLEMS MAY NOT ENGAGE IN ANY FORMAL EXERCISE PROGRAM UNTIL A MEDICAL
CLEARENCE FORM IS COMPLETED AND SIGNED BY AN APPROPRIATE PHYSCIAN.
MEDICAL CLEARENCE FORM
I hereby certify that, to the best of my knowledge, the person whose name is signed
above, was physically examined and has no contraindications to participation in rigorous
athletic training designed to enhance fitness and race performance.
Precautions and Limitations to Physical Training: _______________________________
_______________________________________________________________________
_______________________________________________________________________
Patient’s Name: _________________________________
Signature of Physician: ___________________________
Type or Printed Name: ___________________________
Date: _______________ Phone: ___________________
Physician’s Address: ____________________________
____________________________
____________________________
