2016 Player Bio and Availability Form

FULL Name AS ON ID (This is for air travel)

Preferred Name (What name do you use)

Date of Birth (Needed for air travel)

Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day 12345678910111213141516171819202122232425262728293031 Year 20162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940

Cell Phone #

Email

Occupation

Weight

Height

Hometown

Playing Experience

Years

Preferred Position

Biggest Life Influence

Name your Racehorse

Availability

(Select the games you are available for):

May 21st / Home / UnionJune 11th / Away / Atlanta RhinosJune 18th / Home / Tampa MayhemJune 25th / Away / Central Florida WarriorsJuly 2nd / Home / USARL South 9s TourneyJuly 9th / Home / Atlanta RhinosJuly 16th / Away / Tampa MayhemJuly 30th / Home / Central Florida WarriorsAugust 6th / TBD / USARL South Playoff SemiAugust 13th / TBD / USARL South ChampionshipAugust 29th / Away / USARL South Championship

Emergency Contact

Phone Number

Relation

Medical Insurance (include number)

Medical History

Current Medications

Current Supplements

Have you had a concussion? YesNo

If Yes how many?

Past Illnesses

Past Medical Procedures

Past Sport Related Injuries

Past Hospitalizations

Allergies