Amateur Athlete Eligibility Form

Full Name

First NameLast Name

Date of Birth

Date

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Home Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Which sport(s) are you applying for?

Have you ever received compensation or played as a professional in your declared sport(s)?

Please provide a brief summary of your athletic experience (years of participation, clubs, teams, etc.)

Do you have any medical conditions or injuries that may affect your participation? If yes, please specify.

If you answered yes above, please describe your medical condition or injury.

Emergency Contact Name and Relationship

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Signature of Athlete (or Parent/Guardian if under 18)