Application Form - Florida's #1 Post-Graduate Basketball school

PRO HOLMES SPORTS ACADEMY APPLICATION

Applicant Information

First Name		Middle Name
Last Name		Date Of Birth
Address		City
State		Zip
Email		Phone
Height		Weight
Current School		Position
SAT Score		ACT Score
Instagram		Twitter
Are you a citizen of the United States?		Are there any colleges currently recruiting you?
Will you Need Housing?		Are you a full Academic Qualifier?
Recruitment

Education

High School		Address
From		To
Did you graduate?		Diploma

Please answer all questions completely and honestly. This information is kept confidential and assists the Office of Admissions with gaining valuable knowledge about you, the student. Failure to answer truthfully may result in the disqualification of your application and future removal from Prep program. Attach a separate sheet if additional space is needed.

Has the applicant ever been:

Has the applicant ever been involved with law enforcement authorities, charged and/or convicted of a crime or misdemeanor?
Out-of-school suspended?
Expelled?

References

Full Name		Relationship
Company		Phone
Address
Full Name		Relationship
Company		Phone
Address

Applicants Athletic Gear Info

This information will be utilized to secure athletic gear in the event that your student athlete is admitted into Pro Holmes Academy Please ensure accuracy of sizes provided. Replacement gear will not be ordered. If accepted into the program, parents are responsible for purchasing the attire required by our school affiliate. Additional information provided to accepted applicants.

Athletic Shirt Size		Athletic Pant Size
Athletic Shoe Size

Applicant�s Medical Information

Prior to enrollment, you must provide a medical history form and recent sports physical completed by a physician clearing your athlete to participate in contact sports. Pro Holmes Prep will only accept sports physicals obtained on, or after, August 1, 2019. Enclose the medical history form and sports physical with your application.

Applicant�s Physician Phone		Fax
Has the applicant ever been diagnosed with a communicable disease?		If yes, please list disease(s).
Does the applicant have any of the following allergies?
Environmental Allergies?		Food Allergies?
Medication Allergies?		Latex Allergies?

INSURANCE INFORMATION

Insurance Name		Address
Insured�s Name		Date Of Birth
Address		City
State		Zip
Policy		Phone
Group		Fax
SS

EMERGENCY CONTACT INFORMATION

Name		Fax
Relation		Cell

Disclaimer and Signature

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liabilities incident to my minor child�s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

NAME OF PARENT OR GUARDIAN		SIGNATURE OF PLAYER
Date