East Brunswick H.S. Boy's Lacrosse

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Student-Athlete Information Form

This form provides the coaching staff with all the necessary information for eligibility and recruiting. You will be asked to update this information periodically. The information is sent directly to Coach Severino and is kept confidential.

Form

General Info

1. First Name*

2. Last Name*

3. Year of Graduation*

4. Date of Birth*

5. Street*

6. City*

7. Zip*

8. Home Phone #*

9. Student Cell #*

10. Student Cell# Provider*

11. Student Email*

12. Parent Email*

13. Father's Name

14. Mother's Name

15. Emergency Name*

16. Emergency #*

School & Athletic Info

17. What type of helmet will you be using this season*

18. GPA*

19. Height*

20. Weight*

21. Preferred Jersey #

22. 40yd time

23. 2mile time

24. Bench Press (1 rep max)

25. Squat (1 rep max)

26. Other High School Sports Played (level)

27. Position (check all that apply)*

	Attack
	Midfield
	Face-Off
	Long-Stick Mid
	Defense
	Goal

* required field

Blackhawks
Youth Lacrosse
East Brunswick, NJ

blackhawkslacrosse.com

Quick Links:
www.highschoolsports.net
www.njilca.org
www.njlacrosse.org
www.maxpreps.com
www.laxpower.com
www.teamhomefield.com
www.universallacrosse.com
www.lax.com
www.mycentraljersey.com
www.nj.com