XCELL PERFORMANCE GROUP

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application for personal coaching

To initiate a coaching program, or just send some background info, please take some time to complete and submit this form (feel free to choose 'not sure' at the bottom of the page if you're not ready to commit). Answer the questions as accurately as possible; I'll get back to you ASAP and ask for additional details during a phone consultation.


Name:
Address:
City:
State/Province:
Zip:
Country:
Birthday:
Primary phone:
Preferred contact time:
I'd like you to help me with the following sport(s):
I train with a heart rate monitor: Yes:   No:  
What is the highest heart rate you've seen recently? 
What is your lowest resting heart rate? 
My dietary habits are:  Excellent:  Adequate:    Need work:  
My knowledge of nutrition is:  Excellent:  Average:   Basic:  
What was your longest training week ever (hours)?: 
Approximate training week currently (hours): 
Approximate training time available per day with a typical work/workout schedule:
Monday
Tuesday
Wednesday 
Thursday
Friday
Saturday
Sunday
Group workouts that you regularly participate in (if any): 
Your athletic background: 
Brief multisport competitive history (if any): 
Number of years training in each sport:      Swim:    Bike:    Run: 
Number of years competing in each sport:  Swim:    Bike:    Run: 
Outstanding performances:
Strengths:
Weaknesses:
Recurring sports injuries: 
Health issues that restrict your training: 
Competitive goals for this season:
This season's target races with dates and distances:
Other comments:


Waiver

I am fully aware that participating in any exercise program can be a potentially dangerous, hazardous activity. I am specifically aware of the potential dangers of participating in the XCell Performance Training Group training programs.

In consideration of my acceptance into the XCell Performance Training Group training program, I, the undersigned (parent or guardian if participant is under 18 years of age) intending to be legally bound, do hereby for myself, my heirs, executors, administrators, and assigns, assume any and all risks of participating in said training programs, and I hereby waive and release any and all rights and claims for damages I my have against Jackie Arcana, representatives, successors, and assigns for any and all injuries, all such risks being known and appreciated by me. I hereby waive and release the above named persons, and entities, their representatives, employees, successors, and assigns from any and all claims or liabilities of any kind arising out of my participation in said training programs, even though these claims and liabilities might arise out of the negligence or carelessness on the part of the persons named above. I attest and verify that I am physically fit and prepared for the XCell Performance Training Group training programs, and that a licensed medical doctor has verified my physical condition within the last six months.

I hereby assume full responsibility from any injury, including my death occurring while participating in, or as a result of, my participating in the XCell Performance Training Group training programs, and hereby release, waive, discharge and covenant not to sue Jackie Arcana, successors, representatives, employees, assigns, or other participants in the XCell Performance Training Group training programs from any and all liability to me, my personal representatives, heirs, successors, and assigns for any loss or damage and claim or demands therefore on account of injury to me, including my death, whether caused by their negligence or carelessness in advising me while participating in the XCell Performance Training Group training programs.

You agree that this Agreement constitutes "a writing signed by You" under any applicable law or regulation.

I agree to the above :  


 

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