Thank You!

I can't say how delighted I am to start working together!

All that I need is for you to fill in the below information.

This is the information I need to provide you with your running program.

After submission, please give me 3-5 working days to get your program sorted.

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in

Coaching Questions

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

E-Mail Address*

Age*

Height (in cm)*

Weight (in kg)*

Medical Conditions

Personal Best Times of the Last Two Years? (distance, time and date achieved)

Personal Best Times Ever (More than 2 years ago - distance, time and approx. year achieved)

Why do you want coaching?*

What is your immediate, short-term goal? And when is your goal race?*

What is your long-term goal (over the next few years)

Describe your running training in the last month (number of workouts, types of workouts, length of workouts, etc.)*

Average Weekly Mileage in Last Month (in miles or km)*

Highest Weekly Mileage in Last Month*

Longest Long Run in Last Month*

Highest Weekly Mileage Ever

Longest Long Run Ever

Other non-running training / cross training you do (bike, weights, rowing, etc.). etc.)?

What is your access to cross training facilities like (do you have a home gym, weights, stationary bike, access to a gym, etc.)?

Restrictions to your training - days you can't train, length of training on certain days, holidays / events, anything that could disrupt your training?

Anything else I should be aware of? E.g. any issues with running performance in the past, anything you have not told me yet, that I really should know about?

By pressing the submit button and ticking the box you agree to the following waiver and liability release: "I hereby attest that I am in good health and capable of participating in a vigorous training program for the purpose of improving my fitness. I understand the risks of participating in any physical activity and the risks associated with running programs in particular. I have consulted a liscensed medical doctor to verify my ability to engage in a high level running conditioning program. I understand that a training program provided online is more limited than direct personal contact with a coach. I can make no claims in case of injury or in case of not making my performance goals. I hereby for myself, my heirs executors and assigns, waive, release and hold harmless Dominique de Rooij and all relatives, heirs and successors from any and all claims, demands, liabilities, rights or causes of action arising out of or in connection with participation in activities proscribed by the a*

Yes, I agree

Please enter the word that you see below.