NORTHWEST MISSISSIPPI COMMUNITY COLLEGE

MEN/WOMEN TRYOUTS FORM

(Print clear)

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