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Personal Information
First name
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Last name
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Email
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Phone
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Birthday
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Day
Month
Year
Emergency Contact Name and Phone Number
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Medical History
Diabetes
Hypertension
Heart Disease
Asthma
Allergies
Epilepsy
Other
Allergies
Do you smoke or drink alcohol? If so, how often?
Any other health issues I should know about?
How many days do you exercise each week?
How long have you been exercising regularly?
Less than 3 months
3-6 months
6-12 months
1+ years
Primary activities
Walking
Running
Gym / Strength training
Other
Current Running Ability
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<2km
2-5 km
5-10km
10km+
What is the maximum number of days you are available to train each week?
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What support are you wanting from a coach? How many Days can you commit to training? What days are you available to train?
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What are your running goals (a particular race, distance, time)? What time frame do you hope to achieve these goals?
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I confirm that all information above is accurate and I agree to participate at my own risk, releasing Happy Strides Coaching/ Emma Norris from liability.
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