WHS ATHLETIC DIRECTOR QUESTIONNAIRE

This questionnaire is to be completed in FULL by each person trying out for athletics at Washington High School. Please print, use full names (no nick names) and fill in all questions. Submit this form when finished. It is necessary that a form be completed for each sport that one tries out for throughout the school year.

1.  Enter your Full Name (Last, First, Middle):*____________________________________________

 2.  Enter today's date (mm/dd/yy):*_____ / _____/ _____

3. Enter your Student ID#:*___________________________

 4.  Sport:*___________________________

 5. Enter your Age:*_________

6. Enter your Birth Date (mm/dd/yy):*_____ / _____ / _____

7.  Check your grade level:*

            9          10        11        12

8.  Enter the year you entered WHS:* 20_____

9. Enter the City and State of Birth:* __________________________ , __________

10. Enter Father's Name: ___________________________

11. Enter Mother's Name: ____________________________

12. Enter Current Address:*_____________________________, _________ , ________, ___________

Street                                                City              State           Zip

13. Do your parents live in Jefferson County? (Washington High School Zone)*

Yes                  No

14. What School did you attend school last semester?*_____________________________

 To be eliglble, you must:

 1. Have passed four (4) subjects the preceding semester (2 core classes)

 2. Have a C (2.0 grade point average) the preceding semester for all classes

 3. Have a Birth Certificate on file in the school office.

 4. Have a Physical Exam Form on file in the trainer's room.

 5. Have an Insurance Release Form on file with the coach and trainer.

 15.  Student Signature and Date:*__________________________________   _____ / _____ / _____

 16. Parent Signature and Date:*__________________________________   _____ / _____ / _____