Member Registration Form
Fill out the form carefully for registration
Student-Athlete's Information
Student-Athlete's Full Name
*
First Name
Middle Name
Last Name
Grade (as of September 2021)
*
Please Select
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
How did you hear about 360 Academic Sports Academy?
*
School
Parent
Current member
Internet Search
Social Media
Other
Birth Date
*
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Male
Female
N/A
Age
*
Please Select
11
12
13
14
15
Race
*
Please Select
Black/African American
Hispanic/LatinX
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Asian
White
Other
Ethnicity
*
Example: Caribbean, Latin X, African, Korean
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Local Travel/Local Team
Student-Athlete's Education
Type of School
*
Please Select
PUBLIC
CHARTER
PAROCHIAL
PRIVATE
BOARDING
HOME-SCHOOLING
Name of School
*
Name of School Guidance Counselor
IEP
*
Please Select
Yes
No
Primary Parent/Guardian Information
Parent/Guardian's Full Name
*
First Name
Last Name
Is your address the same as the student-athletes?
Yes, my address is the same as the student-athlete
No, my address is different
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Please enter a valid phone number.
Mobile Phone
*
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Parent/Guardian's Email Address
*
example@example.com
Employment
*
One paid full-time job
One paid part-time job
More than one paid part-time job
No paid job
Name of Employment
Education
*
Some high school/no diploma
High School diploma/GED
College degree
Advanced degree
Is there a secondary parent/guardian information that you would like to provide?
*
Please Select
Yes
No
Parent/Guardian's Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Please enter a valid phone number.
Mobile Phone
*
Please enter a valid phone number.
Parent/Guardian's Email Address
*
example@example.com
Employment
*
One paid full-time job
One paid part-time job
More than one paid part-time job
No paid job
Name of Employment
Education
*
Some high school/no diploma
High School diploma/GED
College degree
Advanced degree
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