Personal Information

First Name*:

Last Name*:

Male/Female*: Male Female

Email*:

Date of Birth: date_month January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 date_year

Address:

City/Town:

Province/State:

Country:

Postal/ZIP Code:

Telephone*:

Height:

Weight:

School Information

Your School*:

City/Town*:

School Telephone:

Area of Study

Program*:

Sports Information

Sport*:

Position:

Current/Last Team:

Years Played:

Current/Last Coach:

Coach's Telephone:

Other Comments:

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I give the Trent University Athletic Department permission to access my academic grades to determine potential admission and potential financial assistance