Lincoln-Way Xplosion Tryout Registration Form 2011/2012 Season Survey

Please fill out the questions below to register for tryouts for the 2011/2012 season.

If you are registering multiple children, you must fill out a seperate form for each child.

*
1. In order to participate in the Xplosion Basketball program you must live in District 210.

I certify that my child lives in the district 210 District.

In order to participate in the Xplosion Basketball program you must live in District 210. I certify that my child lives in the district 210 District. Yes

*
2. Players First Name

Players First Name

*
3. Players Last Name

Players Last Name

4. Players Birth Date

Players Birth Date

5. Address

Address

*
6. City

City Mokena Frankfort	Frankfort Square New Lenox	Manhattan Tinley Park
Other (please specify)

*
7. Gender

Gender Male

Female

8. Height

Height

*
9. School Grade your son or daughter is in (2011 / 2012 School Year)

School Grade your son or daughter is in (2011 / 2012 School Year) 3rd 4th	5th 6th	7th 8th
Other (please specify)

*
10. Team Trying out for

Team Trying out for 3 Boys (New for 2011-2012)

4 Boys

5 Boys

6 Boys

7 Boys

8 Boys

4 Girls

5 Girls

6 Girls

7 Girls

8 Girls

*
11. Who did you play basketball for last year ?

Who did you play basketball for last year ? Xplosion Park District	None (Just Starting) Other
Other (please specify)

12. What other sports do you play ?

What other sports do you play ?

13. Phone Number (with area code)

Phone Number (with area code)

*
14. Primary Email Address

Primary Email Address Email Address
**Re-Enter Email Address

15. Secondary Email Address

Secondary Email Address

*
16. What school do you attend

What school do you attend

*
17. What High School will your child attend ?

What High School will your child attend ? Lincoln-Way East Lincoln-Way Central	Lincoln-Way North Lincoln-Way West
Other (please specify)

*
18. What positions do you currently play ?

What positions do you currently play ? Point Guard

Guard

Forward

Center

Not Sure

19. Would you or your spouse be interested in coaching?

Would you or your spouse be interested in coaching? Yes

20. How did you hear about our program ?

How did you hear about our program ? Xplosion Camp LW Camp Played last Year Newspaper (Other) Newspaper (Mokena Messenger) Newspaper (Frankfort Station) Newspaper (New Lenox Patriot)	Sign Street Sign (Carefree Sprinklers) Flier Friend or Family Member School Handout Web Search Lincoln-Way High School
Other (please specify)

21. If you are a returning player and are selected for the 2011/2012 team, Please answer the following:

If you are a returning player and are selected for the 2011/2012 team, Please answer the following: My Current Uniform still fits	My Uniform will need to be replaced for a bigger size
Current Uniform #

Lincoln-Way Xplosion Tryout Registration Form 2011/2012 Season

1. Player tryout registration form

*1. In order to participate in the Xplosion Basketball program you must live in District 210. I certify that my child lives in the district 210 District.

*2. Players First Name

*3. Players Last Name