Player Questionnaire

SAMPLE PLAYER QUESTIONNAIRE

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Administration – SAMPLE Soccer Player Questionnaire

SEASON: _____________________

TEAM

ORGANIZATION

COACH

PLAYER QUESTIONNAIRE

(To be completed with Parent or Guardian)

PLAYER’S NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

____________________________________________________________

BIRTH DATE: _______________________________

CURRENT AGE: _______________________________

NICKNAME/CALL BY: _______________________________

HOME PHONE: _______________________________

CALLING RESTRICTIONS, IF ANY: _________________________________________________

PLAYER’S CELL PHONE: _____________________________

APPROVAL TO CALL PLAYER’S CELL PHONE (Y/N): _________

PLAYER’S E-MAIL ADDRESS: ______________________________________________________

APPROVAL TO SEND E-MAIL TO THIS ADDRESS (Y/N): _________

MOTHER’S NAME: _____________________________________________________________

MOTHER’S CELL PHONE: ______________________________________________________

MOTHER’S WORK PHONE: ______________________________________________________

CALLING RESTRICTIONS, IF ANY: ____________________________________________

MOTHER’S HOME E-MAIL ADDRESS: _______________________________________________

MOTHER’S WORK E-MAIL ADDRESS: _______________________________________________

E-MAIL RESTRICTIONS, IF ANY: ______________________________________________________

FATHER’S NAME: ____________________________________________________________

FATHER’S CELL PHONE: _____________________________________________________

FATHER’S WORK PHONE: _____________________________________________________

CALLING RESTRICTIONS, IF ANY: ___________________________________________

FATHER’S HOME E-MAIL ADDRESS: _______________________________________________

FATHER’S WORK E-MAIL ADDRESS: _______________________________________________

E-MAIL RESTRICTIONS, IF ANY: ______________________________________________________

ANY KNOWN MEDICAL CONDITIONS OR ALLERGIES: __________________________________

_________________________________________________________________________________

HAS THE PLAYER EVER HAD A CONCUSSION (FROM ANY CAUSE)? Yes No

DOES PLAYER NORMALLY WEAR GLASSES OR CONTACT LENSES? Yes No

PREVIOUSLY REGISTERED? Yes No Don’t Know

IF PREVIOUSLY REGISTERED, PLAYER ID NUMBER: ____________________________________

PLAYER’S SOCCER EXPERIENCE: _________________________________________________

__________________________________________________________________________________

MOST RECENT COACH’S NAME AND PHONE # ___________________________________________

SOCCER CAMPS ATTENDED, IF ANY: _________________________________________________

__________________________________________________________________________________

PLAYER’S PREFERRED POSITION, IF ANY: ___________________________________________

PLAYER’S PREFERRED JERSEY NUMBER, IF ANY: _______________

FRIENDS WITH TEAMMATES (FIRST AND LAST NAMES): _____________________________

__________________________________________________________________________________

POSSIBLE CAR-POOL ARRANGEMENTS WITH: __________________________________________

AVAILABILITY FOR POSSIBLE TOURNAMENTS: (Please Circle)

MEMORIAL DAY WEEKEND Yes No

LABOR DAY WEEKEND Yes No

COLUMBUS DAY WEEKEND Yes No

VETERANS’ DAY WEEKEND Yes No

THANKSGIVING DAY WEEKEND Yes No

SIGNATURE: ___________________________________

DATE: ___________________________________