School holiday program questionnaire

Thank you for registering for the School holiday running technique program. We just need you to fill out this questionnaire to help us know as much as possible about your child’s running history and background before we begin.

Thank you for your support.

Your name:
Child's Name:
Age & session time: *
Address:
Suburb:
Post code:
Email: *
Mobile:

Medical clearance

My child is fit to run and has no pre-existing medical conditions that would preclude their participation in an active running coaching program: *
My child has a medical condition but has been cleared to run by a medical doctor. Please bring medication if needed for treatment of conditions such as asthma: *
Please let us know if there is anything you think we need to be aware off during the program:

Injury history and status

Does you child get injured or sore in similar areas? Does the pain get worse as running continues or goes away after a good warm up? Please describe:

Current level of fitness and activities

Is your child currently involved in Track & Field? Either at a Club or through School? Please describe:
What are the main sports that your child participates in on a regular basis?
Describe a typical week of training and/or competitions:

Feet, shoes and orthotics

What shoes, makes and models does your child wear for running:
Are orthotics or inserts used? If yes describe what they are designed to do:

Thoughts about my child's running

What are your observations about your child's running :
Describe any additional relevant advice received from a professional or coach:

Disclaimer and terms & conditions

We can’t guarantee your child won’t get sore or injured during this coaching program. However we will take all reasonable precautions to minimise any risks. You acknowledge and accept that there are risks of getting sore or injured from making changes to your running technique. If you do not accept these risks please do not use this Service.

You accept all risks associated with participation in this program, including but not limited to falls, injury and any adverse medical event whether pre-existing or spontaneously occurring for yourself and your heirs and executors, you hereby waive, release and forever discharge the Running Technique Channel Pty Ltd its Directors and Shareholders, agents, representatives, successors and assigns, and all other associated persons, for all liabilities, claims, actions, or damages that I may have against them arising out of or connected with my use of the Services. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise.

Please visit and read the full Services terms and conditions of Running Technique Channel Pty Ltd at http://www.runningtechniquecoach.com/terms-and-conditions-2/

I have read, understood & accept the terms and conditions of service: *

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