PCU Registration Form

Name of Athlete:

Parent / Guardian Name:

Address:

Phone:

Age:

Height:

Weight:

Email:

What grade are you in?

Which sport(s) do you participate in?

Which school do you attend?

What are your short term goals?

What are your long term goals?

List any medical concerns:

Emergency contact name & phone number:

Which Position do you play?

Sign Me For PCU Football:

Modified Group

JV / Varsity Group

(OLine) Group: (6/22)

(DLine) Group: (6/22)

(WR) Group: (6/22)

(RB) Group: (6/22)

Pay As I Go: (6/22)

List all dates you plan on attending:

One on One price: (Contact for availability)

$75.00 per session

Feel free to Venmo Payment: @Trent-Patterson-14

*** (Pay as you go) ***

(6/22)

*** (Be sure to list dates you plan to attend) ***

$35.00 per session

*** One on One Price ***

(Contact to schedule)

$75.00 per session