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:*__________________________________ _____ / _____ / _____