GoCentenary.com
Athlete Questionnaire
Thursday, November 15, 2007

Personal Information:
First Name (Legal)
Last Name (Legal)
Nickname
Street Address
City
State
Zip Code
Home Number
Cell Phone
Email Address
Date of Birth
Height
Weight

Parental and Family Information:
Mother's Legal Name
Father's Legal Name
Number of Siblings

High School Information:
Date of High School Graduation
High School Name
High School Mailing Address
High School City
High School State
High School Zip Code
High School Phone
GPA
Class Rank
SAT Score
ACT Score
Extra Curriculum Activities
Possible Collegiate Majors
Are you registered with the NCAA Clearinghouse?

Sports Specific Data:
HS Coach Name
HS Coach Phone
USA/YMCA Team Name
USA/YMCA Coach Name
USA/YMCA Coach Phone Number

Best Times:
50 Free
100 Free
200 Free
500 Free
1000 Free
1650 Free
100 Fly
200 Fly
100 Back
200 Back
100 Breast
200 Breast
200 IM
400 IM
Average Yards Per Day
Sessions Per Week

Diver:
1 Meter Score (6 dives)
1 Meter Score (10/11 dives)
1 Meter List
3 Meter Score (6 dives)
3 Meter (11 dives)
3 Meter list