Personal Information

Student name *

First Name

Last Name

Preferred name/nickname

Student age *

Parent/Guardian Name *

First Name *

Last Name *

Mobile number *

Email *

Softball Information

Current team(s) *

Years playing fastpitch softball *
Less than 1 year1 year2 years3 years4 years5 years6+ years

Years pitching (if applicable)
Less than 1 year1 year2 years3 years4 years5 years6+ years

Level of softball currently playing *
RecTravel ball A levelTravel ball B levelTravel ball C levelhigh schoolOther

Has the student had lessons before? *
YesNo

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) *
FastballChangeupDropCurveDrop curveRiseScrewballOther

How often does the student currently practice on her own (not counting lessons or team practices)? *
Fewer than 1 time per week1 time per week2 times per week3 times per weekMore than 3 times per weekShe doesn't practice on her own

Does the student have access to a facility or space to practice in the winter/bad weather? *
YesNo

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? *
YesNo

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? *
YesNo

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? *
YesNo

If yes, is the student seeing a physician. PT or other healthcare professional for this condition?

Does the student experience any pain that only appears while playing softball? *
YesNo

If yes, where is the pain and what triggers it?

Does the student have any learning disabilities that might affect instruction? *
YesNo

If yes, what type?

Anything else that might restrict the student's ability to participate in lessons?