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We are passionate about running and even more passionate about helping people. Let us help you take your running to the next level.

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Personal Information
Name*
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Date of Birth*
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Sex*
Contact Information
Email*
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Phone*
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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Stats
Height
Please enter a number from 140 to 240.
Weight
Please enter a number from 30 to 140.
Goal Weight (if different to current weight)
Please enter a number from 30 to 140.
Training Age*
- Less than 1
- 1 to 2
- 2 to 3
- 3 to 4
- 4 or more
Are you a Sprinter or Distance Runner*
PB's (Personal Bests within the last 12 months)
Enter your times for any applicable distances
100m
200m
400m
800m
1500m
5km
10km
21.1km (Half marathon)
42.2km (Full marathon)
50km
Comrades Up Run (87km)
Comrades Down Run (90km)
Running Goals
Short-term (12 months) goals*
Long-term (beyond 12 months)
Training Preferences
Days on which you CANNOT train
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
Preferred Long Run
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Total training hours available each week
What has been your total mileage per week over the last 6 weeks:
Week 6
Week 5
Week 4
Week 3
Week 2
Week 1
Injuries
Do you struggle with recurring injury*
- No
- Yes
Injury Details*
Are you injured at the moment*
- No
- Yes
Current Injury Details*
PAR-Q and Consent
PAR-Q & YOU (A Physical Activity Questionnaire for People Aged 15 to 69) Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 to 69, the Par-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: SELECT YES or NO
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommened by a doctor? (required)*
- No
- Yes
Do you feel pain in your chest when you do physical activity? (required)*
- No
- Yes
In the past month, have you had chest pain when you are not doing physical activity? (required)*
- No
- Yes
Do you lose your balance because of dizziness or do you ever lose Consciousness? (required)*
- No
- Yes
Do you have a bone or joint problem (for example, back, neck, knee, hip) that could be made worse by a change in physical acticity? (required)*
- No
- Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? (required)*
- No
- Yes
Do you know any other reason why you should not do physical activity? (required)*
- No
- Yes
IF you answered YES to one or more questions: Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which which questions you answered YES. You may be able to do any activity you want - as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice. Find out which community programs are safe and helpful for you.
IF you answered NO to all PAR-Q questions, you can be resonably sure that you can: start becoming much more physically active - begin slowly and build up gradually. This is the safest and easiest way to go. take part in fitness appraisal - this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active. DELAY BECOMING MORE ACTIVE: if you are not feeling well because of a temporary illness such as a cold or fever - wait until you are better or if you are or may be pregnant - talk to your doctor before you start becoming active.
PLEASE NOTE: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.
I agree that I have read, understood and completed this questionaire to the best of my knowledge. I acknowledge that I am healthy and that I have obtained medical clearance from my doctor in order to take part in the coaching services offered by RunEtics. I hereby indemnify RunEtics against any claim or demand arising from death or injury arising from participation in the strength, conditioning and coaching programs of RunEtics.
*
- I agree to and have read the above paragraph
INFORMED CONSENT AGREEMENT Thank you for choosing to use the services, and programs of RunEtics. I request your understanding and cooperation in maintaining both your and my safety and health by reading and signing the following INFORMED CONSENT AGREEMENT. I declare that I intend to use some or all of the activities, programs and services offered by RunEtics, and I understand that each person, (myself included), has a different capacity for participating in such activities, programs and services. I am aware that all activities, services, and programs offered are either educational, recreational, or self-directed in nature. I assume full responsibility during and after my participation, for my choices to use or apply, at my own risk, any portion of the information or instruction I receive. I understand that part of the risk involved in undertaking any activity or program is relative to my own state of fitness or health (physical, mental or emotional) and the awareness, care and skill with which I conduct myself in that activity or program. I acknowledge that my choice to participate in any activity, service and program of RunEtics, brings with it the assumption by me of those risks or results stemming from this/these choice(s) and the fitness, health, awareness, care and skill that I possess and use. In addition, I understand that I am free to withdraw from, reduce, or modify my involvement in any program activity and I realize that I should do so upon recognition of any signs of transient lightheadedness, fainting, chest discomfort, leg cramps, nausea, etc. I further understand that the activities, programs, and services offered by RunEtics, are sometimes conducted by personnel who may not be licensed, certified, or registered instructors or professionals. I accept the fact that the skills and competencies of some employees and or volunteers will vary according to their training and experience and that no claim is made to offer assessment or treatment of any mental physical disease or condition by those who are not duly licensed, certified or registered and herein employed to provide such professional services. In addition, I acknowledge that I have inquired about the nature of any activity, program, or services that I am not completely familiar with and I have been informed of any inherent risks. I declare that I have read, understand, and agree to the contents of this INFORMED CONSENT AGREEMENT in its entirety.
Consent*
I agree to the above contents of the INFORMED CONSENT AGREEMENT
Terms and Conditions*
I have read (https://runetics.com.au/coaching-terms-and-conditions/) and agree to the Terms and Conditions
Privacy Policy*
I have read (https://runetics.com.au/privacy-policy/) and agree to the Privacy Policy
Signed on this day*
DD slash MM slash YYYY
Signature*

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Address

Unit 2, 56 Creaney Drive
Kingsley, Perth 6026

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Call Us

(08) 6558-1895

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OFFICE HOURS

Mon & Wed: 8am – 7pm
Tue, Thu, Fri: 8am – 5pm

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EMAIL US

info@runetics.com.au

Sign Up with Ray

Please Complete the Sign Up Form?

Personal Information

Contact Information

Stats

PB's (Personal Bests within the last 12 months)

Running Goals

Training Preferences

Injuries

PAR-Q and Consent

Have a question?

Address

Call Us

OFFICE HOURS

EMAIL US