Swimming Questionnaire

Personal Information:

Name: Birth date: / /
Parents/Guardians' Names: Gender: M     F
Home Address:
City: State:  ZIP:
Home Phone: e-mail:
Cell Phone:      

   

Academic Information:

High School: Graduation Year:
Desired Major:  
CGPA:

SAT: (CR)

(M) ACT:
Class Rank: out of Advanced Courses Taken:

 

Athletic Information:

Coach: Coach's e-mail:
Height: Weight: Average Weekly Practice Yardage:

Years Experience:

Dryland
Yes     No

Weights
Yes     No
Best Times:  
  Free Back Breast Fly
50

100
200
  IM
200
400
  Distance
500
1000
1650

List All Additional Extra-Curricular Activities: