PerformingMind Registration Form

Participant Registration Form:

I understand and agree to the Terms of Use and Indemnity clauses as listed on the PerformingMind website Please tick

Section A:

Surname:

First Names:

Date of Birth:

Home Address

Postal Address

Tel (Home):

Tel (Work):

Tel (Cell) :

Email Address
(for course correspondence)

Name of person/organisation responsible for fees payment

Contact No:

Email:

Section B:

* Note that it is important that you complete this section properly, as it helps us understand your needs better, and hence be in a better position to provide you with relevant feedback throughout the programme.

Age:

Sport:

Level:     Status:

Goals

What was the first goal you remember setting yourself?

To what extent have you over the years tended to achieve your goals / not?

Current short term goals (<6 months)

Current medium term goals (6 months-2yrs)

Current long term goals (>2 years)

Please list your upcoming important events?

Performance History

Achievements/things you are most proud of:

Lowest points/setbacks/disappointments:

Important milestones along the way :

Other:

Outside of sport you are:

(If applicable) Please elaborate on either your type of work, or course of study.

Other interests/things you spend significant amounts of time on:

Who are the most important people involved in your sporting career? (Please also indicate to what extent each of these have either a positive or negative influence) :

Other family members involved in sport: (please indicate highest level at which they played):

Have you had any previous contact with psychology (sport psychology or otherwise)? If so, please elaborate on when, for how long, and for what reason:

Significant past injuries or other medical concerns

Expectations:

What are you hoping to get out of this programme?

What would have had to have happened by the end of this program, for you to feel it had been worthwhile?

How will you know when/whether this has been achieved?