Can Run Base Skills Coaching Form Email * Name * First Name Last Name Date of Birth * MM DD YYYY Phone * (###) ### #### Address * Emergency and Medical Information Emergency Contact * The name and number of someone we can contact if we need to. Medical Conditions * Please tell us about any medical conditions or injuries you have that may affect your ability to train. Running Ability Your approximate 5km running time. Approximate 5km Running Time * Running Goal * Running Location Choose your location * Hansen Park Hagley Park Ashgrove Park (Rangiora) Choose your session Choose a session from the location chosen above Hansen Park Tuesday 6 - 7 pm ($130) - Coaching Hagley Park Wednesday 11 - 12 noon ($130) - Coaching Ashgrove Park (Rangiora) Wednesday 6 - 7 pm ($130) - Coaching How did you hear about us? Thank you!
