Powerlifting pre-screen
Thank you for your enquiry with North Shore Barbell coaching. In order to design the best programme for you we must first gain some valuable information on you. Please take your time to answer the following questions thoroughly.
Sign in to Google to save your progress. Learn more
Full Name *
Preferred Name(s)
Email  *
Date of Birth *
MM
/
DD
/
YYYY
What city do you live in? *
Are you a student? *
What is your current weight? *
What is your goal weight? *
What weight class do you want to compete in? *
How many times per week are you currently training? (Consistently) *
How many years have you been resistance training? *
What days of the week would you like to train? (this should align with the chosen frequency of training) *
Required
Do you have a competition planned? If so, when? *
What are your best competition lifts (squat, bench, deadlift and total) and when were these done? If yet to compete please leave blank and refer to the next question.
What are your best lifts across the squat, bench and deadlift over the past 6 months? Please include all relevant rep PB's i.e. 1rm's and/or 3rm, 5rm etc.
What is your current weekly training frequency across the squat, bench and deadlift (including competition variations)? For example - squat x2, bench x 2, deadlift x 1 *
What have you enjoyed about previous training programmes you have done? *
Please state any exercises or programming styles that you have found work well for you.
Have you used an RPE (rate of perceived exertion) style of training before? If yes, did you find it worked well for you?
What are your powerlifting goals? *
How important are these goals to you? *
What other health and fitness goals do you have?
How important are these goals to you?
Clear selection
What barriers do you come across when looking to achieve these goals?
What other exercise are you doing outside of Powerlifting training?
What equipment do you have available to train with? *
What is your occupation?
On a scale of 1-10  how physically exerting is your occupation? (where 10 is extremely exerting)
Clear selection
Have you received coaching for powerlifting before?
Clear selection
If yes - how was your coaching experience?
Please list any relevant injuries
Please list any medical conditions you feel may be relevant.
What coaching option are you interested in? *
When would you like to start with NSBB coaching? *
MM
/
DD
/
YYYY
Do you agree to the terms & conditions stated below?
North Shore Barbell Coaching (NSBBC) and its personnel are not registered dietitians or nutritional specialists. All the guidance you will receive from NSBBC will be based off the coaches own experiences and knowledge. It is highly recommended that if you wish to pursue a powerlifting programme that you consult with your general practitioner (GP) before doing so. Before undertaking coaching under NSBBC please read and understand the following You (customer) fully understand that you (customer) may acquire injury/health issues as a result of the training programme provided to you by your coach at NSBBC. By acknowledging this you are releasing NSBBC from any liability associated with injury acquired from your prescribed training, including, but not limited to heart attacks, death, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury. By submitting this application, you state that in consideration of your participation in NSBBC's powerlifting meet preparation program, you for yourself, your personal representatives, administrators, heirs and assigns, hereby holds harmless, NSBBC from any claims arising from your participation in the powerlifting meet preparation/fitness.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms