2017-18 Women's Lacrosse Sports Information Form

Please fill in the required information with an asterisk (*);
If any of the information below is missing or incomplete, it will not be accepted.

 


Personal Information:

Full Name (First and Last)*:  

Preferred Name on Roster: 

Academic Class (Fr./So./Jr./Sr.):* 

Age*:      DOB* (MM/DD/YYYY): 

Ht*(Ex - 5-11):    

Hometown*: 

High School Attended*:   

Major*:  Minor: 

Student ID Number*:

College Address*:

Dorm-Number/Off Campus Address:

If you live on campus, just put down the Dorm and Room number. There is no need to put the rest of the campus address.

City:     State:    

Zip:


Permanent Address*:

Street/Apt. Number:  

City:    State:     

Zip:


Parent/Guardian Name(s)*:  

Parent/Guardian(s) Address:

Check here if this is same as Permanent Address

Street/Apt. Number:

City:   State:   

Zip: 


Personal Emergency Contact Information*:

Local/Cell Phone:   

Worcester E-Mail:   @worcester.edu

(If you do not have a worcester-e-mail please leave field blank)

 

In case of Emergency, Please Notify:

Name: 

Relationship:

Primary Number or Cell Phone: 

Home Phone: 

Work Phone:

Additional Information That Might Be Needed In Case of An Emergency:

 


Athletic Information

Position/Events*: 

Years Played at WSU* (Not including current one):  0   1  2  3 4

Athletic Class (Fr./So./Jr./Sr.):*   

Hometown Newspaper*:  Weekly:   Daily:

Academic Honors Achieved (while at Worcester State): 

High School Awards/Honors Received:






If you have attended a previous institution where you participated in collegiate athletics:

 Previous School:       Years Attended:

 


SPECIAL FEATURES: Newspapers are always looking for interesting stories about local student-athletes. That information is not easy to come by. If there is anything athletically or outside of the realm of athletics that you think people would find interesting about you please list it here. It could be a hobby, an experience or someone you are related to, etc. Thanks!





The Worcester State Athletics Department wishes to inform you that there is an inherent risk in participating in any varsity sport. This notice is to make sure you are aware and understand the risks involved. All athletes must have their own insurance coverage.

Insurance Company*: 


I HAVE READ AND UNDERSTOOD THE ABOVE NOTICES AND INFORMATION

Please Print Name Here:   Date: 


Please review all of the information on this page to insure that you haven't missed anything. If a required field has not been filled in, it will be marked in red above.

If any important information that is not filled in (address, contact information, etc.) the Sports Information Director will not sign off on any equipment form.