PLEASE PRINT AND COMPLETE AND RETURN TO ATHLETIC TRAINER KINGWOOD HIGH SCHOOL

KINGWOOD HIGH SCHOOL
SPROTS MEDICINE

PRINT STUDENT'S NAME: (LAST FIRST MIDDLE)

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GRADE:_____ DOB : ___/___/____ EMAIL :______________@__________________

CELL:  (_____)______-__________

PARENT / GUARDIAN

HOME ADDRESS:

STRETT: ______________________________________________________________

CITY:_______________________ ZIP: ___________

HOME PHONE: (_____)______-________________

EMAIL ADDRESS:____________@__________________________

MOTHER NAME:_________________________________________

WORK PHONE: (_____)______-_______________

CELL PHONE:    (_____)______-_______________

EMAIL:___________________@________________________________ 

FATHER NAME: (____)______-_________________

 WORK PHONE: (_____)______-_______________

CELL PHONE:     (_____)______-_______________

EMAIL:____________________@________________________________

HAVE YOU EVER RECEIVED A DISCIPLINE REFERRAL FOR ANYTHING OTHER THAN TARDIES?
____ YES ____ NO

IF ANSWERED YES PLEASE EXPLAIN: __________________________________________________________

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HOW MANY DAYS HAVE YOU BEEN ABSENT THIS PAST YEAR? (PLEASE HAVE COUNSELOR INITIAL) : ___________

GRADE: (GPA or AVERAGE LETTER GRADE) __________________

HAVE YOU EVER FAILED A CLASS? _____ YES ____ NO

IF YES WHAT CLASS AND YEAR: ______________________________________

WHAT EXTRA-CURRICULAR ACTIVITIES DO YOU PLAN TO BE INVOLVED IN AT SCHOOL AND AWAY FROM SCHOOL: _____________________________________________________________________

LIST THE CLASSES YOU PLAN TO TAKE IN THE UP COMING SCHOOL YEAR:
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REFERENCES:

NAME RELATION PHONE


1. ___________________________________________________________________________________________


2. ___________________________________________________________________________________________


3. ___________________________________________________________________________________________






I HAVE ANSWERED AND COMPLETED THE APPLICATION TRUTHFULLY. I AM AWARE OF THE NEEDED WORK ETHIC AND UNDERSTAND THAT GOOD GRADES ARE THE PRIORITY OF THE PROGRAM:

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STUDENT SIGNATURE                                                                                     DATE      


I HAVE READ THE APPLICATION AND MY CHILD HAS MY FULL CONSENT TO APPLY FOR A POSITION ON THE STUDENT ATHLETIC TRAINING STAFF:


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PARENT / GUARDIAN SIGNATURE                                                                   DATE