2210 Monroe Ave Brighton, NY 14618 (585) 697-3338 www.fleetfeetrochester.com [email protected]

Sehgahunda Trail Marathon Training A Project Lab Rat Experiment This program will prepare runners for the 2 nd Annual Sehgahunda Trail Marathon. Sehgahunda is the real deal. It may just be one of the hardest trail marathons in the east. It’s 26.3 miles of single track trails, over 3000 feet of climbing, and over 100 gullies that need to be traversed. All that and an 8 hour cut off. This 16 week program will help runner’s prepare physically for the event, while providing educational and emotional support along the way. Important Program Dates: Program Start Date – February 7 th, 2011 Informational Sessions – January 24th and February 3rd @ 6PM (Fleet Feet Sports) Training Runs – (including but not limited to) February 27th, March 20th, and April 16 th Coaches: Head Coach: Boots (course designer and originator of Project Lab Rat) Assistant Coach: Mark Monachino (experienced distance and trail runner) Requirements:  Must have been consistently running at least 5 days a week for the last 3 months and be able to train for a rugged marathon, including up to 4 hour runs  Is not currently injured, but must be willing to risk getting injured  Must be planning to run Sehgahunda  Must like running on trails This program will include:  Detailed Daily Training Program  Group Trail Runs  Individualized Coaching Support  Program Specific Apparel Item  Workshops (including Event Day Nutrition, Orientation/Gear Talk, and Surviving Sehgahunda)  Coupon Book of Savings Program Fee: $195 (includes registration for the race) To Register: Bring cash or check (payable to Fleet Feet Sports) along with completed health evaluation and waiver to Fleet Feet Sports by February 7th, 2011.

2210 Monroe Ave • Rochester, NY 14618 • (585) 697-3338 NO REFUNDS AFTER February 28th, 2011

Date Pd_________ Rec’d Coupon Book _________ Amt ________ Method_____

Health & Exercise Evaluation Form This form is intended to obtain necessary information about your health that will assist Boots in designing an appropriate th program. Please return this form to Fleet Feet no later than February 7 along with $195 (cash or check). No refunds after February 28th! Name_____________________________________________ Today’s Date ____________ Birth Date __________________ Address __________________________________________ City, State, Zip _______________________________________ Home Phone ____________________________ Work Phone __________________________ Age _________________ E-mail: _______________________________________________________________________________________________ Gender: M

F (circle one)

Height _______________ Weight ___________

Tech Shirt Size: S

M

L

XL

How did you hear about the program: ______ FF Newsletter _______ FF Website _______ Facebook _______ Friend Other ____________________________________________________________________________ EMERGENCY CONTACT INFORMATION (Please list a family member of close friend whom we may contact in case of emergency) Name_____________________________________________ Phone(s) __________________ Relationship ______________ BLOOD PRESSURE Do you have high blood pressure? Have you ever had high blood pressure in the past? Are you currently on medication for high blood pressure? SMOKING Do you smoke? Y

N

Y Y Y

N N N

Are you a former smoker? Y

N

Date Quit? _________________________

HEART AND CIRCULATORY PROBLEMS Have any of your blood relatives had heart or circulatory disease, heart surgery or angina? Y

N

If yes, please give details: ______________________________________________________________________________________________________

Have you ever been told by a doctor that you have heart problems, circulatory problems, high cholesterol or triglycerides? Y N If yes please indicate specific history below and give dates: Heart Attack Date: _____________ Cardiac Pacemaker Date: _________________________ Heart Bypass Date: _____________ Angina Date: _________________________ Coronary Balloon Angioplasty Date: _____________ Irregular Heart Rhythms Date: _________________________ Stroke Date: _____________ Rheumatic Heart Disease Date: _________________________ High Triglycerides Date: _____________ Heart Murmurs Date: _________________________ High Cholesterol Date: _____________ Number? _________________

SURGERIES/INJURIES/MAJOR ORTHOPEDIC PROBLEMS AND ILLNESSES Have you ever had any surgeries, injuries or illnesses that limited or would limit your ability to exercise? Y

N

If yes, please describe: ___________________________________________________________________________________

2210 Monroe Ave • Rochester, NY 14618 • (585) 697-3338 NO REFUNDS AFTER February 28th, 2011

Date Pd_________ Rec’d Coupon Book _________ Amt ________ Method_____ PHYSICAL THERAPY, CHIROPRACTIC or other alternative medical therapies (Acupuncture, Massage therapy etc.) Have any of your injuries required physical therapy or chiropractic attention? Y If yes, give dates:

N

Are you currently involved in physical therapy, chiropractic or alternative therapies? Y If yes, with whom? Have you ever experienced any of the following: (Circle all that apply) Anemia Asthma Pulmonary Disease Kidney Disease Arthritis Fainting spells Poor Vision Swelling of hands/feet Knee Pain Shoulder Pain Osteoporosis Fibromyalgia Epilepsy Diabetes

N

Diabetes Cancer Type/Date Back/leg pain Poor Hearing Ankle Pain Thyroid Problems Stress Fracture

MEDICATIONS Please note any medications you are currently taking: Name of Drug Reason for Taking

OTHER Is there any other medical reason not mentioned here that would limit your ability to engage in physical activity? If yes, please describe:

2210 Monroe Ave • Rochester, NY 14618 • (585) 697-3338 NO REFUNDS AFTER February 28th, 2011

Y

N

Date Pd_________ Rec’d Coupon Book _________ Amt ________ Method_____ Athletic Background Most recent race (any distance): Date of Event: ______________ Most recent Marathon: Date of Event: ______________ Best Marathon: Date of Event: ______________

Distance: _________

Distance: _________

Distance: _________

Time: _______

Time: _______

Time: _______

Longest Trail Event Completed: ____________________ Best Performance in last 2 years: Distance Time Race 5K _____ _____________

Date ______

Best Performance Ever Time Race _____ ____________

8K

_____

_____________

______

_____

____________

______

10K

_____

_____________

______

_____

____________

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½ Marathon

_____

_____________

______

_____

____________

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Marathon

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_____________

______

_____

____________

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Date ______

Training History over LAST YEAR: Average Weekly Mileage _______________________

Number of days Running/Week_____________

Average easy run Pace _________________________

No. of days willing to train per week ______________

Average Long Run Distance ______________________________

How often do you train on trails? ____________________________________________________________________ Did you participate in Sehgahunda last year? Y

N

If yes, in what capacity? ___________________________________________________________________________ If you completed the event what was your finishing time: ___________________

What if any injuries have you experienced in the last year? _________________________________________________ _________________________________________________________________________________________________

2210 Monroe Ave • Rochester, NY 14618 • (585) 697-3338 NO REFUNDS AFTER February 28th, 2011

Date Pd_________ Rec’d Coupon Book _________ Amt ________ Method_____

GENERAL STATEMENT RE: PHYSICAL EXERCISE & FLEET FEET SPORTS I understand that my decision to engage in physical exercise with Fleet Feet Sports/Ellen Brenner and David Boutillier and its staff/coaches/pace leaders may include exercises, facilities and/or equipment designed to improve muscular strength and cardiovascular endurance. Description of Potential Risks associated with Physical Exercise I understand that the reaction of the heart, lung, and blood vessel system to physical exercise cannot be predicted with accuracy. I understand that there is a risk with certain abnormal changes during or following physical activity. These changes may include, but are not limited to abnormal changes in blood pressure, heart rate, ineffective functioning of the heart, and in rare cases a heart attack (cardiac arrest, or possibly death). Use of weight resistive equipment or engaging in heavy body calisthenics can lead to musculoskeletal strains, pain or injury. I understand that a stretching program with a warm up period before and a cool down period after engaging in physical exercise can reduce the risk of pain and injury. Information regarding warm-up, cool down and stretching exercises will be provided to me by an instructor during my scheduled orientation. I also understand that running on trails presents increased risks and additional opportunities for injury. Responsibility of Client I have completed the medical history profile and understand that I must disclose all of my physical and medical conditions, limitations and sensitivities. I understand that Ellen Brenner/David Boutillier reserves the right to request permission from my physician if it is determined I may be at a high risk for injury or medical complications. I understand that it is up to me to request instruction for a particular machine or exercise if I am unsure of its operation or purpose. Emergency Care I understand that I must inform David Boutillier immediately if I experience any problems while working with him or under his workout instruction. I understand that David Boutillier and Mark Monachino or any of coaches/pace leaders are not medical professionals in their suggestions or opinions must not be considered medical advice. Any information imparted to me should be discussed with a health care professional. In the event of a medical problem, I further recognize that any medical care that may be required is my personal financial responsibility. Release of Liability Statement I have read the foregoing information and understand it. Any questions which may have occurred to me have been answered to my satisfaction. I understand that I am free to deny answers to specific items or questions during interviews or when filling out questionnaires, and to decline to participate in any recommended activity. The information which is obtained will be treated as privileged and confidential and will not be released or revealed to any person other than my physician without my expressed verbal or written consent. I agree that all instruction in use of equipment or exercises shall be undertaken at my own risk and I further agree that I am physically and mentally able to undertake any and all instructions provided. I certify that this program is undertaken at my sole choice and risk. Name (print) ______________________________________________ Signature ______________________________________________

Date _________________

2210 Monroe Ave • Rochester, NY 14618 • (585) 697-3338 NO REFUNDS AFTER February 28th, 2011