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INTERSCHOLASTIC ATHLETIC QUESTIONNAIRE

Bentworth School District

Interscholastic Athletic Questionnaire

Date:*

Answer Required

School:*

Answer Required

Bentworth Middle School

Bentworth High School

Student's Legal First Name*

Answer Required

Student's Legal Middle Name

Answer Required

Student's Legal Last Name*

Answer Required

Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal

Answer Required

Phone:*

No dashes: 7242396787

Answer Required

Date of Birth*

Answer Required

Grade:*

Answer Required

Previous School:*

Answer Required

Were you participating in interscholastic athletics at your previous school?*

Answer Required

YES

If "Yes", please list the sport(s):

Answer Required

Would you like to participate in athletics at Bentworth?*

Answer Required

Yes

If "yes", please list the sport(s):

Answer Required

Students that transfer for purposes of athletic intent will be declared ineligible according to the P.I.A.A. rules.