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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:    ___________________________________
 Any undefined soccer words, terms, or phrases may be found in The ULTIMATE SOCCER DICTIONARY of American Terms available at Amazon.com.
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John C. Harves
CoachingAmericanSoccer.com®
All Rights Reserved
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