Athlete Intake Form

First Name:

Middle Initials:

Last Name:

Gender:

Street Address:

Apt./Unit #:

City:

State:

Zip Code:

Phone Number

Email:

example@example.com

2.Which best describes your current fitness level? You may select more than one and provide more information in the following question response

Primarily walk

Walk-Jog intervals Primarily run or jog

3. Which days and times work best for you to participate?

4. Do you prefer to run in a pair or on your own?

If you have an athletic partner in mind, what is their name?

6.Do you prefer to have a male or female participant matched to you?

Male, Female, No preference

7. What are your hobbies and interests?

8.How far are you willing to travel from your home to visit someone? We are currently recruiting in Roanoke City and County. Check all that apply

SouthEast NorthWest Cave Spring Grandin Vinton Hollins area Salem

9. What is your occupation?

Are you afraid of dogs?

What size t-shirt do you wear?