My Profile

 

 

 

Sign Up via Cheque or EFT

Great! Let's get started - please complete the following form and press 'Submit' when complete.  As soon as I receive payment I'll be in touch and we can start to develop your personal program.

Personal Information
Name
Address
City
State
Phone

(Please leave no gaps when entering mobile number)

Mobile
Email
Age
Sex
Running Profile
Current weekly mileage
Longest run of the week
Number of days you run each week

Briefly describe a typical training week for yourself

History of Injuries
How long have you been running?
General Medical Condition

Are you involved in any other forms of training other than running? If so, can you please advise what that may be and where it fits into your current week.

Personal Best (PB) and Most Recent (MR) times for the following distances if known
5km PB    MR
10km PB    MR
1/2 Marathon PB    MR
Marathon PB    MR
Briefly outline your personal goals over the next 12 months
Any other comments you would like to make
How did you hear about my online coaching program?

Payment (Prices are in Australian dollars)
Please contact me for a quote if you require a program where the duration is not accurately covered below.

I have posted a cheque for

$55 = 4 Week program or,

$105 = 8 Week program

$155 = 12 Week program

$300 = 24 Week program

2009 Gold Coast special offer: $300 is my standard 24 week fee which kicks in on Jan 19 2009. We can get a head start though. Sign Up now and start online coaching immediately and only pay the 24 week fee.

made out to Pat Carroll and posted it to:

Pat Carroll
52 Fleetway St
Morningside Qld 4170
Australia

I have quoted my surname and deposited $55 or $105 or $155 or $300 via Internet Banking into:
Account name: Pat Carroll
Account #: BSB: 034037 A/C: 193331

Gift voucher recipients: Please select cheque option.

Waiver and Release

I acknowledge that a training program set by Pat Carroll involves strenuous cardiovascular activity and it is my sole responsibility to ensure my physical condition is not at risk by participating in such a strenuous activity.

It is necessary to have a physical exam by a physician before beginning any strenuous exercise program.

I understand the risks involved in running, walking or other fitness activities and assume personal responsibility for my health and safety while participating in this program.

I am in proper physical condition to undertake a running program. I release Pat Carroll from any and all claims or damages arising from my participation in an individualised training program.

I also understand and accept the following responsibilities:

Pat Carroll's Responsibilities:
 To design an individualized training program taking into consideration the runners current fitness level and future goals.
 To be continually available via email to offer advice on any running related matters.
 To reply to emails within 24 hrs (except during public holidays) and to ensure any basic questions sent via email relating to nutrition are answered with 48hrs. 

Runners Responsibilities:

To advise Pat Carroll your progress via email. This being your results from training sessions and racing whenever applicable.
Notify Pat Carroll when you may be in the early stages of an injury or illness so the appropriate adjustments can be made to your program.

I accept these terms outlined above
Full Name:
Date:
 
 

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INTRAINING

 

 

 

 

 

 

 

 

 

 

 
Pat Carroll - Online Running Coach

 e: pat@patcarroll.com.au