New Student Intake Form
Personal Information
Student name
*
First Name
Last Name
Preferred name/nickname
Student age
*
Parent/Guardian Name
*
First Name
Last Name
Mobile number
*
Email
*
example@example.com
Softball Information
Current team(s)
*
Years playing fastpitch softball
*
Less than 1 year
4 years
1 year
5 years
2 years
6+ years
3 years
Years pitching (if applicable)
Less than 1 year
4 years
1 year
5 years
2 years
6+ years
3 years
Level of softball currently playing
*
Rec
Travel ball C level
Travel ball A level
High school
Travel ball B level
Other
Has the student had lessons before?
*
Yes
No
If yes, with whom and for how long? (Please list all previous coaches if you remember)
What pitches was the student taught? (Please check all that apply)
Fastball
Drop curve
Changeup
Rise
Drop
Screwball
Curve
Other
How often does the student currently practice on her own (not counting lessons or team practices)?
*
Fewer than 1 time per week
3 times per week
1 time per week
More than 3 times per week
2 times per week
She doesn't practice on her own
Who catches for the student during lessons?
*
Does the student have access to a facility or space to practice in the winter/bad weather?
Yes
No
Student Goals
What are the student's highest priorities right now? (Examples: throw faster, learn or improve a particular pitch, reduce strikeouts, learn to slap)
*
What are the student's longer-term goals? (Examples: get an opportunity to pitch, make a particular team, play in high school, play in college)
*
Other Activities
Does the student participate in other sports?
*
Yes
No
If yes, please list the sport(s) and level played (rec, club, AAU, etc.)
How long is the season for each non-softball sport?
How much time do other sports require each week?
Which sport is the student's priority? (Please be honest, if it's not softball it's not a disqualifier)
What other interests or hobbies does the student have?
Injury/Medical History
Has the student had any injuries that required her to not participate in softball or other sports in the past? (Please list all that apply and for how long she was out)
*
Does the student have any other health conditions that could affect her, such as diabetes, scoliosis, asthma, etc.?
*
Is the student currently under the care of a physician, PT, or other healthcare professional for an injury or other condition?
*
Yes
No
If yes, what injury or condition?
Does the student have any chronic pain (such as back pain) regardless of activity level? If so, what type?
*
If yes, is the student seeing a physician. PT or other healthcare professional for this condition?
Yes
No
Does the student experience any pain that only appears while playing softball?
*
Yes
No
If yes, where is the pain and what triggers it?
Does the student have any learning disabilities that might affect instruction?
*
Yes
No
If yes, what type?
Anything else that might restrict the student's ability to participate in lessons?
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