Paratriathlon Introductory Questionnaire
Paratriathlon Introductory Questionnaire
Thank you for your interest in Paratriathlon. Please fill out this questionnaire to help us get to know you and your goals better.
*
1
. What is your full name (first and last name)?
What is your full name (first and last name)?
*
2
. Where do you currently reside (city/state)?
Where do you currently reside (city/state)?
*
3
. Phone Numbers
Phone Numbers
Primary Phone
Cell Phone
*
4
. Email Address
Email Address
*
5
. Date of Birth
Date of Birth
*
6
. Gender
Gender
Male
Female
*
7
. Are you currently, or have been in the past, a member of the United States Armed Forces?
Are you currently, or have been in the past, a member of the United States Armed Forces?
Yes
No
8
. Describe your disability.
Describe your disability.
9
. To the best of your knowledge, what Paratriathlon category do you believe you would fit into?
To the best of your knowledge, what Paratriathlon category do you believe you would fit into?
TRI 1 - Handcycle: Paraplegic, Quadriplegic, Polio, Double Leg Amputee.
TRI 2 - Severe Leg impairment: Above-knee Amputees.
TRI 3 - Les Autres: Includes athletes with Multiple Sclerosis, Muscular Dystrophy, Cerebral Palsy, Double Leg Amputee (runners) or Paralysis in multiple limbs.
TRI 4 - Arm impairment: Including Above and Below Elbow Amputees or "impairment" in one or both upper limbs.
TRI 5 - Moderate leg impairment: Below-knee amputees.
TRI 6 - Visual Impairment: Legally Blind. (20/200 vision with best corrected vision).
*
10
. Have you been classified in another Paralympic Sport?
Have you been classified in another Paralympic Sport?
Yes
No
*
11
. Have you ever completed a triathlon?
Have you ever completed a triathlon?
Yes
No
12
. What other sports have you competed in since your injury or impairment?
What other sports have you competed in since your injury or impairment?
Swimming
Cycling/Handcycling
Running/Push chair
Skiing
Other (please specify)
13
. Name your current triathlon coach.
Name your current triathlon coach.
14
. How much time are you dedicated to training per week for triathlon?
How much time are you dedicated to training per week for triathlon?
*
15
. What are your short term Paratriathlon goals?
What are your short term Paratriathlon goals?
*
16
. What are your long term Paratriathlon goals?
What are your long term Paratriathlon goals?
*
17
. Do you have your own Paratriathlon equipment (wetsuit, bike/handcycle, race chair, etc)?
Do you have your own Paratriathlon equipment (wetsuit, bike/handcycle, race chair, etc)?
Yes
No
Other (please specify)
*
18
. Are you currently competing competitively in any other Paralympic Sport?
Are you currently competing competitively in any other Paralympic Sport?
Yes
No
Other (please specify)
*
19
. Why do you want to race in Paratriathlons?
Why do you want to race in Paratriathlons?
*
20
. Would you like to be added to the monthly USA Paratriathlon newsletters?
Would you like to be added to the monthly USA Paratriathlon newsletters?
Yes
No
Powered by
SurveyMonkey
Check out our
sample surveys
and create your own now!
Javascript is required for this site to function, please enable.