Bike Fit Questionnaire

LEGAL STUFF: BY COMPLETING THIS QUESTIONNAIRE YOU CONFIRM, ACKNOWLEDGE AND AGREE to the risk, release of liability, indemnification agreement and covenant not to sue

In consideration of purchasing a bike fit from P. Dave Jordaan dba CyberCycleCoach (Releasees) I hereby freely agree for myself, my heirs, executors, administrators, legal representatives, assignees, and successors TO WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNIFY AND NOT TO SUE the Releasees that are in any manner connected with bike fitting, including any and all purchases of product, equipment or clothing, FROM ANY AND ALL RIGHTS AND CLAIMS INCLUDING CLAIMS ARISING FROM MY OR THE RELEASEES’ OWN NEGLIGENCE, which I have or which may hereafter accrue to me, and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation in or association with a bike fit including travel to or return from the bike fit. I ALSO understand, agree and do not object to the fact that bike fitting at times involves touching and adjustment of the body by the fitter AND I hereby consent to the use of my name, image, likeness, and testimonial(s) in photographs, videos, and other media posted on Cyber Cycle Coach’s social media channels for promotional and marketing purposes without further consent or compensation. I understand and acknowledge that such content may be publicly visible and shared by third parties.

  • Personal Information

  • Number of hours worked each week
  • small, medium, large
  • US & European if you know it
  • high arch, wide, etc.
  • Waking 3 day average for full 60-second count
  • Highest seen within the last 12 months
  • Athletic History

  • Describe all the excercise you currently do
  • Describe your Cycling Hydration, Energy Gel, Food Bar habits
  • Cycling Goals (be specific as possible)

  • This field is for validation purposes and should be left unchanged.