GETTING STARTED:

Please print out these pages and fill out the following forms as accurately as possible. If you have any questions at all about anything on the form please feel free to contact me by phone (610) 873-7355, by fax (484) 765-1801. After I receive these forms, I am usually prompted with more questions for you and will call you to further get to know you. When I am satisfied that I have all of the information that I need to get started with your training plan you will be given a start date and can expect to receive your first week's training schedule via fax or email. You will also receive a username and password to the athletes area of this this web site which includes more information regarding the workouts, nutrition and your training plan.

Thanks for your interest and I hope to hear from you soon.

BASIC

Date_____/______/______

Name__________________________________________________
Street___________________________________Apt____________
City____________________________State_______Zip_________
Country________________________________________________

FAX( )_______________________________________________

E-mail Address__________________________________________________

Home phone ( )________________
Work phone ( )________________
Cellular ( )_____________________
Pager ( )_______________________

M____F_____

Birthdate_____/_____/______Age______________



COMPUTER

Operating System (i.e., Windows 95, MacOs, etc.)____________

Email application you use (Outlook Express, Eudora, Netscape, etc)
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Word Processing application/versions you use or prefer (Word, Wordperfect, AmiPro, etc)
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Spreadsheet applications/version you use or prefer (Excel,Lotus,etc)
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How would you prefer to receive your training schedules each week?
Email_______ Web Page________ Fax_________ Snail Mail__________



PERSONAL

Occupation?_____________________________Hrs/week_______ Same hours each week?_______
Very Stressful?_______Stressful?_________Not Stressful?_______
Married?___________Children? __________ If yes, how many?________ Ages?________


ATHLETIC BACKGROUND
How many years have you been training for endurance sports?______________________
Which sports?__________________________________

How many years have you been competing in endurance sports? _______________
Which sports?__________________________________

How many years have you been training/competing in other sports? __________________
Which sports?_________________________________

Please list your best race results and times.

Event Result and Time
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Any other accomplishments you would like me to know about:
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YOUR CURRENT SCHEDULE

Do you keep a training log?__________If yes, could you submit a typical training week and racing week?_______


Please give an idea of your typical training week - You may use a separate sheet if necessary - be as detailed as possible)

Monday ____________________________________

Tuesday ____________________________________

Wednesday __________________________________

Thursday____________________________________

Friday ______________________________________

Saturday ____________________________________

Sunday _____________________________________


How much time and how often can you train each day?

(i.e., Monday - 1.5 hours, 2x (45 minutes, AM, 45 minutes PM), Tuesday - 2 hours, 1x (PM).

Monday ____________________________________

Tuesday ____________________________________

Wednesday __________________________________

Thursday____________________________________

Friday ______________________________________

Saturday ____________________________________

Sunday _____________________________________


What time do you need to be done training in the morning to get to work on time?___________

What time do you get home from work?___________

What time do you typically go to sleep at night?__________

What are you pool hours and/or schedule swim practice times?

Monday ____________________________________

Tuesday ____________________________________

Wednesday __________________________________

Thursday____________________________________

Friday ______________________________________

Saturday ____________________________________

Sunday _____________________________________

What is your longest training session during the past month?

Swimming_______________ hours ______________ yds/meters
Cycling_______________ hours _______________ mi/km
Running_______________ hours _______________ mi/km

Over the past two months what is the average number hours/week you trained?
Cycling(Road)? _______ Running? ________ Swimming?__________
Cycling(Off Road)?_________ Strength?_________ Other_______


Can you vary your training time? _________ Or do need to train the same hours each week?
(Explain)



Are there any regular group workouts that you participate in?________If, yes please list and describe the workouts as accurately as you can (I.e.,time, intensity, time of day, sport, how many people,)
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CURRENT FITNESS

Rate you current fitness(1=worst shape 10=best shape)? ________
Do you know your maximum heart rate? _______ Running ____ Cycling _______
From a stress test?_________ From race? ____________ From other?___________

Do you know your Anaerobic or Lactate Threshold?______ Running ____ Cycling _______
From a stress test?_________ From time trial?________________
From lactate test?___________ From other? ______________

Do you train with a heart rate monitor? _____________ Which brand/model? __________________

Do you train with a power measuring device (Cycling)?__________ Which brand/model__________________

Please list any times that you know and average heart rates for each (if known).


RUNNING:
BEST: 5-K________________avg. heart rate_________Date__________
10-K______________ avg. heart rate__________Date___________
Marathon__________ avg. heart rate__________Date___________
Other______________avg. heart rate__________Date___________

Most RECENT: 5-K________________avg. heart rate_________Date__________
10-K______________ avg. heart rate__________Date___________
Marathon__________ avg. heart rate__________Date___________
Other______________avg. heart rate__________Date___________

If known: 10 minute Time Trial - Distance covered?____________ Max Hr?___________Date________

CYCLING:
BEST: 10mi_______ avg. heart rate _______________Date______________
40-K________ avg. heart rate _______________Date_______________
112mi________avg. heart rate________________Date_______________
X-Country__________avg. heart rate ________Date______________
Other_________avg. heart rate__________Date_____________

Most RECENT: 10mi_______ avg. heart rate _______________Date______________
40-K________ avg. heart rate _______________Date_______________
112mi________avg. heart rate________________Date_______________
X-Country__________avg. heart rate ________Date______________
Other_________avg. heart rate__________Date_____________


If known: 10 minute Time Trial - Distance covered?___________ Avg Power?_________ Max Hr?__________Date__________

What are your swimming times (please specify yds/meters, long course or short course, with or without wetsuit):
BEST: 200______400_______1500/1650_______ 2.4 mi___________When?_________________
Most RECENT: 200______400_______1500/1650_______ 2.4 mi________When?_________________


If known: 10 minute Time Trial - Distance covered?____________ Date?___________


WHERE CAN YOU TRAIN?

Where can you swim? _________________________________________

How close is your pool?______________

What type of pool will you be training in? ___ 25yd____ 25meter___ 50meter ___ Other
Do you have access to Open Water training?_______

Where can you run? Roads_______ Trails__________Track_________Treadmill____________

Where can you ride? Roads_______Off Road__________Indoor__________

What brand/model treadmill?__________ What brand/model cycle trainer? ____________

What type of terrain do you have available?
Flat_________Rolling Hills_________Steep Hills________Long Hills__________ Mountains_________Technical_________

Where can you strength train? Gym_______ Gym (at pool)_______ Home_______

What strength equipment do you have available? Free weights_______ Cybex_______ Universal_______ Cybex_______ Other______

What brand/size/model bike do you ride?_______________________________________________

Do you have race/TT wheels?_______ What brand/model?______________

GOALS

What is the primary sport in which you are planning to compete?
_____Triathlon_____Duathlon______Running
_____Swimming_____Cycling ______Mt. Biking _______other

If you live within 2-3 hours of the Delaware Valley Area (Philadelphia) are you interested in Personal “Shoulder to shoulder” training?_________________

Please list your three most important goals as an endurance athlete:

1.

2.

3.


GOAL EVENTS

Please list races/events in which you plan to compete in order of importance along with your realistic goals for each.
Race/Event Date Distance Goals
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PERSONAL STRENGTHS AND WEAKNESSES

Rate your ability in each sport (relative to your peers) on a scale from 1(worst) to 5(best):

Swim_____ Bike______ Run_______

Yes No 1. I prefer the toughest conditions a race can throw at me.
Yes No 2. I can squat or leg press more weight than most athletes my size.
Yes No 3. I am and always have been physically stronger than other athletes.
Yes No 4. I prefer hilly courses.
Yes No 5. I am good at sprints.
Yes No 6. I can easily ride and/or run at very high cadences.
Yes No 7. I have always been best at short quick explosive activities.
Yes No 8. I prefer short, fast workouts.
Yes No 9. I am stronger at the end of workouts than most.
Yes No 10. I prefer long races and workouts.
Yes No 11. I have always been able to finish stronger than most regardless of sport.
Yes No 12. I am confident that I will not “bonk” in long races.

Do you consider yourself to be (please check one):
highly motivated________ fairly motivated________ not motivated____________


Do you consider yourself to be (please check one):
very confident__________ fairly confident __________ lacking confidence__________


Do you believe you have the ability to be (please check one:
very focused___________ fairly focused ___________ not focused at all___________

Assign the appropriate number to each of the statements below.

1=Rarely 2=Occasionally 3=Often 4=Always

______ 1. I believe I have great potential as an athlete
______ 2. I believe I am very successful at the things I put my mind to.
______ 3. I can race close to or above my ability level.
______ 4. I am mentally tough.
______ 5. I don’t lose my confidence after I have a bad race.
______ 6. I love to train and rarely miss a planned workout.
______ 7. I am fired up on the morning of a race.
______ 8. I am willing to make sacrifices to achieve my goals.
______ 9. I set very high goals for myself.
______ 10. I try to be the best I can possibly be.
______ 11. I stay positive even when things go wrong.
______ 12. I am positive and pumped up before races.
______ 13. I learn from all of my races - good and bad.
______ 14. The harder the race the better.
______ 15. I can relax before races.
______ 16. I have no self-doubts before races.
______ 17. I have no problem staying focused during races.
______ 18. I am very in touch with my real and perceived effort during races.
______ 19. I can block out distractions during races.
______ 20. I concentrate best when the race gets hard.
______ 21. I can imagine myself doing well in the hardest races.
______ 22. I can visualize handling tough race situations.
______ 23. I can see myself training and racing in my mind.
______ 24. I mentally rehearse strategy, skills and possible race scenarios before races.
______ 25. I can visualize doing well before the big races.

Please list your greatest strengths (mental and/or physical):






Please list your greatest weaknesses (mental and/or physical):






MEDICAL

Are you currently under the care of a physician? Y / N If yes, explain.
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Are you taking any medication? Y / N If yes, please list
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Have you had complete physical in the last year? Y / N

Weight________
Ideal Weight_________
Height__________
%Body Fat____________

Smoke? Never / Quit Over a year ago / Quit less than a year ago / Currently Smoke________

Please mark with an X all of the following that apply to you. Please explain in the space provide or on a separate sheet.

Have you or anyone in your family had coronary artery disease?____

Have you ever fainted or felt dizzy after exercise?____

Has a doctor said that your blood pressure is too high?_____

Do you have heart trouble, a heart murrmur or have you had a heart attack?____

Do you ever have chest, shoulder, neck or arm pains during exercise?_____

Are you diabetic, have a thyroid or any other chronic condition?_____

Is your cholesterol level high?_______

Are you now or have you been pregnant during the last three months?_____


Do you have any conditions that your doctor says may limit your physical activity?
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Do you have any conditions that you think may limit your physical activity?
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Please consult your physician before starting this or any exercise or training program.



WAIVER-YOUR SIGNATURE IS REQUIRED

I acknowledge that training for and/or participating in a triathlon, duathlon, cycling, swimming, running or any other endurance sporting event is an extreme test of my physical and mental limits and that such training and/or participation poses potential risks of serious bodily injury, death, or property damage. I have provided Jeff Devlin with all information which in any way relates to or that could affect my physical health and attest that I am in good health and my physical condition has been verified by a licensed medical doctor.

Furthermore, in return for my participation in this program, I on behalf of myself and my heirs or executors I hereby:

a)WAIVE, RELEASE, and DISCHARGE Jeff Devlin, his officers, directors, administrators, employees, consultants, coaches and agents from any claims, costs or liabilities for personal injury, illness, death or damages of any kind which I may have now, or at any time in the future, resulting from participation in this or any other program;

b) AGREE NOT TO SUE any of the persons or entities mentioned above for any claims, costs or liabilities that I have waived, released or discharged herein;

c) INDEMNIFY, DEFEND, and HOLD HARMLESS, the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions.

I am retaining Jeff Devlin - Human Performance Engineering to coach me in
endurance sports and assist me in the improvement of my fitness. I am
solely responsible for my debit. I agree to pay debits promptly up receipt
of invoice for services. I agree to pay collection fees, if my debits are
15 or more days overdue.

I affirm that I am eighteen (18) years of age or older, I have read this
document and understand it’s contents. (Athlete’s under 18. Parent of
guardian must sign)

Signature______________________________Date_____________________

Parent or
Guardian Signature________________________________Date_____________________
(if under 18 years of age)



Return this form along with payment to Jeff Devlin, H.P.E. (you may also pre-pay for any number of months you like - see payment info) to:

Fax: 484-229-0693