Men's Water Polo
Men's Water Polo Recruit Questionnaire

*Required fields.

Personal Information

Prospect Code: *  
First Name: * Last Name: *
Middle Name: Preferred Name:
Email: *   
Address: * City: *
State: Zip:
Country: Phone: *
Mobile/Alt. Phone: Gender:
Place of Birth: Date of Birth: *
Hobbies:   

Parent/Guardian Contact Information

First Name: * Last Name: *
Relationship: * Home Phone: *
Mobile Phone: Email:
College Attended: Occupation:
Employer: Work Phone:
Extension:   

Parent/Guardian Contact Information

First Name: * Last Name: *
Relationship: * Home Phone: *
Mobile Phone: Email:
College Attended: Occupation:
Employer: Work Phone:
Extension:   

Athletic Information

Height: * Weight: *
Dominant Hand: * Position: *
50 Free: 100 Free:
Other Pertinent Swim Times: Athletic Achievements:

Academic Information

SAT: SAT Math:
SAT Verbal: ACT:
GPA: * Class: *
Class Rank: Grad Year: *
Registered with Clearinghouse: * Yes No Clearinghouse #:
Intended Major: 1st College Preference:
2nd College Preference: 3rd College Preference:

School Information

School Name: * Address 1: *
Address 2: City: *
State: Zip:
Country: Phone:
Fax:

School Coach Information

First Name: * Last Name: *
Email: Title: *
Work Phone: Mobile Phone:
Home Phone:   

Club Information

Team Name: * District/County:
City: * State: *

Club Coach Information

First Name: * Last Name: *
Email: * Work Phone: *
Mobile/Cell Phone: Home Phone:

Verify characters:

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