TELL US ABOUT YOURSELF:                                   

Athlete’s First Name:

Last Name:

Age:

SELECT ONE 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Birthdate:

? 01 02 03 04 05 06 07 08 09 10 11 12 ? 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ? 1970 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Grade Entering this Fall:

SELECT ONE 1 2 3 4 5 6 7 8 9 10 11 12

Sex:

SELECT ONE Female Male

Address:

Address 2:

City:

State:

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip:

VOLLEYBALL INFORMATION:                                        

School Name:

School Type:

SELECT ONE High School Middle School Elementary School Private School

Volleyball Club:

# of Years Played:

SELECT ONE 0 1 2 3 4 5 6 7 8 9 10 11 12

Adult T-Shirt Size:

SELECT ONE Extra Small Small Medium Large Extra Large

Preferred Position:

SELECT ONE Setter Outside Hitter Middle Hitter Setter/Hitter Defense Specialist Not Specialized

How Did You Find Out About the Six Footas Plus Programs?              

SELECT ONE Attended Previously Coach Newspaper Advertisment Promotional Flyer Internet Friend Referral

CONTACT INFORMATION:                                      

Email:

Home Phone:

Mobile Phone:

Mom's Work Phone:

Dad's Work Phone:

Emergency Contact Name:

Emergency Contact Phone:

SELECT SPECIFIC CLINIC OR CAMP:                                        

Which camp or clinic would you like to attend?              

SELECT ONE Private Lesson $70 Semi Private Lesson $50 Private Lessons Package A $240 Private Lessons Package B $300 Private Lessons Package C $330 Fall Youth Series $250 Fall Youth Series One Day $40 Performance Training Session $50 Performance Training Pack A (8 Sessions) $320 Performance Training Pack B (12 Sessions)$435