YOUTH TRAINING PROGRAM PARQ

Please fill out this form as accurately as possible, this will allow better understanding for our coaches so programs can be specified accordingly

Athlete's Full Name

First Name

Last Name

Email Address

Mobile Number

If mobile number unknown, next of kin - mobile number

Date of Birth

MM/DD/YY

Height

Weight

School

Injuries/Hospitlization

Within the past 2 years

If selected YES please describe in detail?

Sport:

Position:

If applicable

Describe overall Training History?

Any form of training outside of sporting commitments

Any experience in weight training at all? If Yes, how many years and what kind of training?

Do you have any past medical history that may restrict you from this program?

If YES please explain in detail?

Are you currently suffering from any injuries that may limit your training? If yes, please explain:

Describe in detail your training goals?

List 2-3

Are you seeing any other Allied Health Professionals? If so please list their Name & Contact Details below.

E.g Exercise Physiologists, Physiotherapist, Occupational Therapist, Dietitian

Anything else you want us know?