Acceleration Pre-Registration

Enter your username and password to load your details into this form (OPTIONAL)
Please simply start entering your contact details below if you do not have a username and password.
Username: *
Password: *
First Name: *
Last Name: *
Email Address: *
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We will not provide your details to any other company.
Date of Birth:
Gender: Male
Female
Sport:
Occupation:
Athlete's Contact Details:
Home Phone:
Mobile/Cell Phone:
Work Phone:
Address:
Suburb/City:
State/Prov:
Zip/Postcode:
Country:
Mother's Contact Details:
Mother's Name:
Mother's Mobile/Cell:
Mother's Email Address:
Father's Contact Details:
Father's Name:
Father's Mobile/Cell:
Father's Email Address:
Injury Concerns
Medical Concerns
Comments
In the next year, what are the two main events/competitions that you are training for?
Name Start Date
eg. 10-Jul-2010		 End Date
eg. 15-Jul-2010		 Description
(if you do not have exact start and end dates, include approximations here)
1. Calendar Calendar
2. Calendar Calendar
What is your ‘dream’ goal?
What is potentially possible in the long-term if you stretch all of your limits?
(E.g. To play for Australia, or Lose 20kg of Body Weight)
What is your ‘dream’ goal for this year? (E.g. Make the State U/16 Team or Lose 5 kg)
Mark 3 goals in priority order that you want to work on in your Acceleration sessions below:
1=Highest Priority, 2 = Moderate Priority, 3= Lowest Priority
Skill Priority Order Rating out of 10
0=Worst 10=Best		 What will you do to ensure you reach your target rating?
(train 2/week)
Present
today		 Target
Event Date
Acceleration
Speed
First Step Quickness
Vertical Jump
Flexibility
Upper Body Strength
Lower Body Strength
Upper Body Power
Lower Body Power
Core Strength
Other
Other
List 1 sport skill that you may be working on concurrently with your Acceleration training:
Sport Skill
(e.g. increased stroke rate,
stronger rebounds,
better kicking game,
better angled drives)		 Rating out of 10
0=Worst 10=Best		 What will you do to ensure you reach your target rating?
(train 2/week)
Present
today		 Target
First Event Date
Note: If you change or cancel your testing session on the day of your booking, you will lose your initial deposit.