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E-Rising Participant Contact & Information Form
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* Indicates required question
Email
*
Your email
Parent First & Last Name
*
Your answer
Student/Player First & Last Name
*
Your answer
Best Contact Number
*
Your answer
Player age
*
Your answer
Date of Birth of Participant
*
MM
/
DD
/
YYYY
Player shirt size
*
XS
S
M
L
XL
XXL
Parent shirt size
*
XS
S
M
L
XL
XXL
Depending on what you are currently registered for, please share participant’s prior years of experience and what skills you/participant would like to focus on the most:
*
Your answer
What skill strengths does your participant have or enjoy the most?
*
Your answer
Please mark all that you would be interested in:
*
Private sessions
Small group sessions
Academic Tutoring in Speech, Communication, Presentations
Academic Tutoring in English Language Arts, Writing
Academic Tutoring in Math
Academic Tutoring in Science
Athletic Sports Team in Soccer, Volleyball, Track, Basketball
Athletic Coaching in Basketball
Athletic Coaching in Track
Athletic Coaching in Cross-Country, Long Distance Running
Athletic and Academic Study Skills
Athletic Coaching in Soccer
Academic Creative Skills Piano
Academic Creative Skills Drawing/Art
Other:
Required
Please confirm, substituting signature, below to the informed consent agreement as a participant of the ERising program.
*
I confirm.
Required
Feel free to share any information/questions/comments the coach should know or that you would like to below here (asthma, learning background, allergies, etc.)
Your answer
A copy of your responses will be emailed to the address you provided.
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