Swimmer Name (required)

Athlete Age (required)

Any health concerns or medical issues (required)?
noyes (explain below)
If you selected "yes" above, please describe:

Athlete Email (required)

Athlete Phone

Emergency Contact
Emergency Contact Name

Contact Phone

Contact Email

Main Swimming Goals (future events, etc.)

How many swims per week?
—Please choose an option—01234567more than 7

CSS pace (if you know it) before COVID:

Do you do any strokes other than freestyle? (if yes, please list)

If so, which strokes would you like these incorporated into some of the workouts?

Any swimming related injuries? (If yes, please explain)

BY SUBMITTING THIS FORM, I AM AGREEING TO THE FOLLOWING:

I acknowledge that training for and/or participating in a bicycle, running, swimming, triathlon or duathlon event is an extreme test of a person's physical and mental limits and such training or participation poses potential risks of serious bodily injury, death, or property damage. With full understanding of the risks I am taking, I HEREBY ASSUME ALL THE RISKS OF TRAINING FOR AND PARTICIPATING IN SUCH EVENTS and agree to the following (initial statement to which you agree at the "Init" space):

(Init) Karyn Austin. has been retained to assist me in the improvement of my fitness.

(Init) I hereby attest that I am in good health and my physical condition has been verified by a licensed medical doctor and, furthermore, the licensed medical doctor has been advised that I intend to participate in these events.

(Init) In consideration of being accepted as a fitness client by Karyn Austin Coaching, I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns, or anyone else who might claim or sue on my behalf: (a) I WAIVE, RELEASE, AND DISCHARGE from any and all claims, costs, or liabilities for death, personal injury or damages of any kind, which arise out of or relate to my training for or participation in a bicycling, running, swimming, triathlon or duathlon event.

(Init) I AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, I HAVE READ THIS DOCUMENT AND UNDERSTAND ITS CONTENTS. I UNDERSTAND THAT BY SENDING THIS DOCUMENT I AM WAIVING SIGNIFICANT LEGAL RIGHTS AND AM INCURRING SIGNIFICANT LEGAL LIABILITIES.