Varsity Registration Form

Email address *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP Code *

Cell Phone Number *

Student Number: *

Years of Eligibility Used *

0 1 2 3 4 5

Height *

Gender: *

Male Female Other

Citizenship *

Domestic International

Program Name: *

Years You have Participated at Centennial College *

1 2 3 4 5

Sport: *

Position: *

Campus: *

Have you Attended Another College or University: *

Yes No

Hometown *

Name of College/University: (If you answered no to the previous question, please write Centennial College as your answer) *

City of Institution: *

Did you Play on the "Varsity Team" at that institution: *

Yes No

Which Sport(s): *

Name High School(s) Attended: *

Number of Years Played at That Institution *

City of Institution: *

Emergency Contact Name: *

Relationship: *

Emergency Contact Email: *

Emergency Contact Phone: *

* required field