Regis University Student-Athlete Information Sheet |
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Email address
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Last Name:
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First Name:
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DOB:
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Local Address:
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Cell:
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Gender:
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Ethnicity:
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American Indian/Alaskan
Asian/Pacific Islander
Black
Hispanic
White
Other
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RUID#:
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SPORT:
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ACADEMIC YEAR:
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MAJOR:
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Summer Activity Questions
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Did you participate in any activities with a professional team?
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Did you receive compensation for your athletic skill (not camps)?
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Did you receive any tangible prize for athletic competition?
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Did you have any contact with an agent this summer?
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Were you involved in any promotional activities this summer?
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Did you sign any contracts/commitments with a professional team?
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Please explain all yes answers:
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Previous Athletic Participation
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Institution 1
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Institution:
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Enrolled Full-Time:
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| (Please list semesters enrolled full time, i.e. Fall 2008, Spring 2009) |
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Practice:
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| (Please list semesters practiced, i.e. Fall 2008, Spring 2009) |
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Competition:
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| (Please list semesters competed, i.e. Fall 2008, Spring 2009) |
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Institution 2
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Institution:
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Enrolled Full-Time:
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| (Please list semesters enrolled full time, i.e. Fall 2008, Spring 2009) |
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Practice:
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| (Please list semesters practiced, i.e. Fall 2008, Spring 2009) |
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Competition:
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| (Please list semesters competed, i.e. Fall 2008, Spring 2009) |
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Institution 3
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Institution:
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Enrolled Full-Time:
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| (Please list semesters enrolled full time, i.e. Fall 2008, Spring 2009) |
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Practice:
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| (Please list semesters practiced, i.e. Fall 2008, Spring 2009) |
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Competition:
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| (Please list semesters competed, i.e. Fall 2008, Spring 2009) |
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Were you recruited to Regis?
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Did you sign a National Letter of Intent?
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Parent's or Legal Guardian Name(s):
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Parent's/Permanent Address:
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Parent's/Legal Guardian Home Phone#
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Parent's/Legal Guardian Work Phone#
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Parent's/Legal Guardian Cell Phone#
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Parent's/Legal Guardian email address(s)
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I understand that illnesses and injuries may occur during my participation in athletics at Regis University. Furthermore, I understand some illnesses and injuries if not reported can cause me further harm, in some cases permanent disability or death. Therefore, I accept the responsibility for reporting my injuries and illnesses including, but not limited to, signs and symptoms of concussions to the Regis University Medical Staff. In addition, by typing my name below, I attest that I have received educational material on concussions from Regis University and agree to read this educational material.
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| * = required field |
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