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INTERSCHOLASTIC ATHLETIC QUESTIONNAIRE

Bentworth School District

Interscholastic Athletic Questionnaire

Date:*

Answer required for "Date:"

School:*

Answer required for "School:"

Bentworth Middle School

Bentworth High School

Student's Legal First Name*

Answer required for "Student's Legal First Name"

Student's Legal Middle Name

Answer required for "Student's Legal Middle Name"

Student's Legal Last Name*

Answer required for "Student's Legal Last Name"

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Phone:*

No dashes: 7242396787

Answer required for "Phone:"

Date of Birth*

Answer required for "Date of Birth"

Grade:*

Answer required for "Grade:"

Previous School:*

Answer required for "Previous School:"

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

Answer required for "Were you participating in interscholastic athletics at your previous school?"

YES

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

Answer required for "If \"Yes\", please list the sport(s):"

Would you like to participate in athletics at Bentworth?*

Answer required for "Would you like to participate in athletics at Bentworth?"

Yes

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

Answer required for "If \"yes\", please list the sport(s):"

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