NORTHWEST MISSISSIPPI COMMUNITY COLLEGE

MEN/WOMEN TRYOUTS FORM

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Name ____________________________________cell#(___)_________ Phone(___)________________

Email:______________________________________

 

Permanent Home Address ______________________________________ County _______________      

 

City _____________________________________________ State ________  Zip __________________

 

Date of Birth ______________________ Age ______  SSN ___________________________

 

Parent or Guardian _______________________________________  Phone _____________________

 

High School __________________________________________ Date of Graduation _______________

 

High School GPA _______________  ACT  __________

  

Best Playing Position ___________________________________________________________

 

 Other playing experience: Club____,  O.D.P.____, Select_____.

 

I fully understand that I am on my own in the tryout.  I hereby relieve Northwest Mississippi Community College and its soccer coaches of any liability for any injury that I might incur during this tryout.

  

Signature ___________________________________________________ Date ______________

 

(This form must be sign and dated prior to tryouts. A parent or a guardian must sign if you are under the age of 18.) 

 

 

 

 TRYOUTS: Feb 18, 2012

WOMEN’S AT 11:00am

MEN’S AT 1:00pm

                                SANATOBIA CAMPUS

Coach Jarjoura #: 662 560 5280                Cell: 662 562 2543

Coach Baldwin #: 662 560 5263