Ric Rojas Running Directory

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School Runners

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Application

*Items in Red are required

Last* Name Street Address* email address*
First* Name City* Home Phone*
Middle Initial State* Work Phone
Birthdate* MO* Day* Yr* Zip* Cell Phone
Primary Event* Secondary Event Pager
Personal Best Primary Event* Hrs Min Sec Personal Best Secondary Event Hrs Min Sec Emergency Contact ph.*
Goal - Primary Event Hrs Min Sec Goal - Secondary Event Hrs Min Sec Best time to call
Running History
Medical History
Miles Run Last 4 Weeks* List Current Medications*

Best Recent Race

List Current Injuries*
Time Hrs Min Sec  
Comments on Running History

Comments on Medical History

Why do you want to be coached?*

Program/Payment Selection
Choose One Level*
Instructions
New Adult Client $275
New Client Includes one-time-only $50 set up fee
Continuing Adult Client $225
Continuing Clients Only
New Student $205
New Student Includes one-time-only $25 set up fee
High School Program $95
Continuing Clients Only
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Ric Rojas will call you within 24 hours to discuss details.