Athletic Information Request

First Name:*

Last Name:

Gender:*

Email:*

Phone number:*

City:*

State:*

Zip Code:*

Mailing Address:*

Parent/Gaurdians Names WITH Cell Number (if under 18 years of age):

Graduation Date:*

Cumulative GPA*

ACT Score:*

Previous School:*

School Address:*

School City:*

School State:*

School Zip Code:*

Sport Interest (choose all that apply):*

Men's Basketball

Men's Soccer

Women's Basketball

Women's Soccer

Position:

Statistics:

Height:

Weight:

Coach Name:*

Coach Phone Number:

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