Player Information (**denotes required field)

**Name:
**Address:
**City,State and Zip Code:
**Phone:
**E-mail:
Current School:
Current Grade:
Birthdate:
Height:	Weight:
Interview Date:

---

Coaches Information

Head Coach(most recent)
Name:
Email:
Home Phone:
Work/SchoolPhone:

---

Supplemental  Information

Position(s):
Events/Times (e.g. 50M Freestyle - 24.79):
                    

Describe your sports experience below:

What other sports (if any) do you play at a competitive level?

**Any additional information (e.g. academic grades, honors, awards, etc.)

For Phone, Mail or Email Inquiries Contact:

Jean Farnum
Head Coach
Phillips Exeter Academy
20 Main Street
Exeter, NH 03833
School Phone: 603-777-4418
E-mail: jfarnum@exeter.edu