Centre Athletics: Swimming and Diving



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Required Fields are red.

Personal Information

Name:

Preferred Name:

Phone Number:

Address:

City:

State:	Zipcode:

Date of Birth:

Email Address:

Father's Name:

Father's Occupation:

Father's College Years:

Mother's Name:

Mother's Occupation:

Mother's College Years:

Academic Information

High School:

HS Phone Number:

HS Address:

HS City:

HS State:	HS Zipcode:

Academic Interests:

Extracurricular Activities:

Academic Honors:

ACT:	SAT Critical Reading:	SAT Math:

Retaking?:	Date:

Graduation Year:	GPA:

Class Rank:	out of

Athletic Information

Height:	Weight:

Previous Injuries:

Major Injuries:

Minor Injuries:

HS Coach:

HS Coach's Phone Number:

Athletic Honors:

Club Name:

Club Coach:

Club Coach's Phone Number:

Other Sports Played:

Do you use weights?	Do you practice twice a day?

Daily Yardage:	Years swum:

Favorite Athlete:

Most Influential Athlete:

If you could meet any 3 people, who would they be?

SWIM TIMES:

Freestyle 50:	FS 100:	FS 200:
FS 500:	FS 1000:	FS 1650:

Breaststroke 100:	BS 200:

Backstroke 100:	BkS 200:

Butterfly 100:	BF 200:

Individual Medley 200:	IM 400:

DIVING:

1 Meter
6 Dives (1m):
11 Dives (1m):

3 Meter
6 Dives (3m):
11 Dives (3m):