Background InfoFirst Name Last Name Date of Birth Parent's Phone Number Child's Cell Number Email Sport InfoSex Male FemaleSport Football Basketball Volleyball Lacrosse Soccer Swim Softball Baseball Cheer Golf Track Recreation Weightlifting Wrestling CricketLevel Middle School High School College Professional OtherPosition Organization School Coach School Coach Email Club Coach Club Coach Email Social MediaSnapchat Twitter Instagram Other Injury HistoryInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot OtherInjury Injury Date Injury Side Right LeftInjury Location Head/Neck Back Abdomen Shoulder Arm Hand Elbow Hip Thigh Knee Leg Ankle Foot Other QuestionnaireWhat are your fitness or athletic goals over the next 6 months? What are your most recent academic and or athletic awards? How can Carlisle Performance help you achieve your goals? How committed are you to accomplishing your goals? How committed are you to attending every scheduled session and giving your best effort? You are only in our presence for 2-4 hours per week. How committed are you to doing what it takes the remaining time to move toward your goals? What type of equipment do you have in your home? Please list. (i.e. Dumbells, Bands, etc.) Where do you anticipate executing the program delivered to you? What is your communication preference? (i.e. FaceTime, Zoom, What's App, etc.) Send
