KINGWOOD HIGH SCHOOL
SPROTS MEDICINE
STUDENT TRAINER APPLICATION: PRINT AND COMPLETE AND TURN IN TO THE TRAINER AT KINGWOOD HIGH SCHOOL 


NAME: (LAST FIRST MIDDLE)________________________________________________________

GRADE:_____ DOB : ___/___/____ EMAIL :____________________________________________

CELL:__(_____)______-______________

PARENT / GUARDIAN

HOME ADDRESS: ________________________________________________________________

HOME PHONE:_(_____)______-__________

EMAIL ADDRESS:_____________________________________________

MOTHER NAME:______________________________________________

WORK PHONE: _(_____)______-_______________

CELL PHONE:     _(_____)______-_______________

FATHER NAME:_(____)______-________________

 WORK PHONE: _(_____)______-_______________

CELL PHONE:     _(_____)______-_______________

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

IF ANSWERED YES PLEASE EXPLAIN: __________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

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:
________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________










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:

____________________________________ ______/_______/_______
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:


____________________________________ ______/_______/_______
PARENT / GUARDIAN SIGNATURE DATE