Please take your time when filling out our fitness questionnaire. Your answers to the questions are IMPORTANT, so I can evaluate them and make safe and effective recommendations for your training program for the 100 mile bike challenge. The boxes in the form expand so please supply as much information as you can.
Your Full Name (required) Your Email (required) Date: Age MALE FEMALE Height Weight Do you smoke? And if YES how many per day? Do you drink alcohol? And if YES how many per week? What is your current weekly exercise program - Please give as much detail as possible inculing distances covered, time spent, different activities, intensities? Will you be continuing with these activities in addition to your 100 mile bike training program? What are your fitness/training goals ? Why are you taking the "100 mile bike challenge" ? Are you more or less fit that 5 or 10 years ago? What has changed? Describe yourself at the moment in time when you were the "fittest you have ever been". How old were you, what activities were you doing, how often, to what level, give me a picture of you at that time.. What is your typical daily food intake? What do you eat and when? Are you taking any over the counter supplements including protein powder and similar products? Which sports person inspires you the most and why? Is there any other information that you feel I should know about in putting together a training program and working with you to succesfully complete the 100 Mile Bike Ride? Before starting any exercise program you should take a basic health questionnaire. This section below will determine if you need to consult a doctor prior to beginning an exercise program. Please answer all questions: Do you have High / Low Blood Pressure? YES NO Are you taking any medication? YES NO Do you experience head or chest pain? YES NO Do you have an injury that could worsen due to exercise? YES NO Have you a medical problem / illness / recovering from surgery? YES NO Do you suffer from a heart condition? YES NO Do you have a family history of heart disease? YES NO Has a doctor ever advised you not to exercise? YES NO Do you think you may be pregnant? YES NO Would you consider yourself to have a disability? YES NO If you answered yes to any of the above, you should consult your doctor prior to commencing this exercise program
I declare that to the best of my knowledge I know no reason why I should not participate in an exercise programme. I take part in the programme entirely at my own risk and waive any legal resource for damage to myself or property arising from my participation.
As with any exercise program, purchaser with a personal history or family history of health problems should consult with a physician before embarking on a new exercise program. I am over the age of 18 yrs. old and have read and fully understand the contents of this declaration and agree to its terms an conditions in full.
By placing your initials in the provided box, you are digitially signing that you understand and agree to the disclaimer terms, and conditions. You must initial the box.
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