Athlete Form

Which location are you applying for?

Personal Information

Name

Sex

MaleFemale

Parent(s) Name(s)

Address

City

State

Zip

Home Phone

Cell Phone

Email

Date of Birth (month/day/year)

Age of Athlete

Grade Level

School Attending

Medical condition(s) that Buddy Up should be aware of:

 

Social Skills & Settings Evaluation

Please list your athlete’s favorite hobbies (games, characters, movies, foods, music):

What motivates your athlete? What is your reward method? (Praise or something tangible, please explain)

Does your athlete have trouble transitioning from one activity to the next? Explain your technique used at home and/or school:

Does your athlete respond better to a male or female? Adult or peer of same age?

Does your Athlete currently participate in special needs based activities?

YesNo

If so, which ones?

Does your Athlete participate in any typical based activities outside of school?

YesNo

If so, which ones?

Is your Athlete potty trained?

YesNo

Does your Athlete use/respond to sign language?

YesNo

What are your goals for your Athlete at Buddy Up? Your athlete's goals?

As a parent of a Buddy Up Athlete, how would you like to get involved?

Fundraising: Help in the securing of funds, goods and/or services in support of Buddy UpRecruit Athletes and Buddies: Promote Buddy Up in the community and local schoolsActivities: Plan quarterly celebrations

 

Emergency Contact Information

Name

Phone

Address

Cell

Relationship to athlete

 

Buddy Up Tennis Fitness and Fun provides one shirt that should be worn to all clinics. Please indicate
your athlete’s shirt size

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XL

If you do not receive a reply within 5 business days, please contact Beth@buddyuptennis.com.