Sports Club Questionnaire

Sports Club Questionnaire Instructions

Competitive Tier and Elite Development runners wishing to join the Kiprunning Sports Club must complete the following questionnaire as part of the entry process.  Coach Komen will use this information to evaluate your running history, current level of fitness, and general health.  Please answer the questions on this form completely and as specifically as possible.  Likewise, when listing your race performance times, please, whenever possible, include valid URLs to your official race results.

The information gathered here will be used solely by Wilson Komen for determining your qualifications for the Kiprunning Sports Club.  He will not share your information with any other person or entity.  Your personal information is strictly confidential.  If you have any questions or concerns about completing this form, please contact Coach Komen.

Please note that the coaching provided by Wilson Komen of Coach Kiprunning is not intended in any way as a substitution for professional medical advice. If you have questions or concerns about your exercise regimen, personal nutrition, injury status, or your overall health, please contact your primary care physician for further assistance.

Personal Information
First Name
Last Name
Street Address 1
?
This field only requires a street address. Add any apartment number information in the optional "street address 2" field.
Street Address 2 (optional)
?
Please enter your apartment number, if appropriate, here.
City
State
Postal Code
Country
Phone Number
?
Please enter your phone number, complete with area code and, as necessary, country code.
Email Address
Age
Sex
Height
Weight
Resting Heart Rate
Medical and Injury History
Relevant Illnesses and Medications ?
This information will help Coach Wilson design an appropriate training regimen. Please complete this field, or enter "n/a."
Currently Injured?
?
Please enter either "yes" or "no."
Injury Type and Prognosis (if relevant) ?
If relevant, please be detailed. Indicate the type of injury, treatment plan, duration of recovery, and date to return to running.
Additional Injury Comments (optional) ?
Feel free to add any comments about your injury history or current injury status that you think will be helpful to Coach Komen.
General Running History
Total Years Running
Average Miles Per Week
?
Rough averages are perfectly acceptable.
Distances Raced (list all)
Current Racing Goals
Sports Club Qualification Standards
?
For each of the following, include your personal records (according to official race finish times), name of race, and (wherever possible) accurate URLs for your race results.
Complete all relevant details:
5KM PR
8KM PR
10KM PR
10 Mile PR
Half Marathon PR
Full Marathon PR
Personal Coaching History
Describe in Detail Your Experience with a Personal Running Coach ?
Discuss experience with past personal running coaches. If none, explain why you are seeking personal coaching. What are your competitive running goals?
Reason for Joining the Kiprunning Sports Club ?
Provide a brief explanation of your reasons for joining the Kiprunning Sports Club.
Prior Team Experience ?
Describe any prior team training and racing experience. Memberships on school-affiliated teams as well as recreational running clubs are all valid experience.
Additional Comments (optional) ?
Feel free to add any additional comments about your training, racing, or medical history that you think will helpful to Coach Komen.