SSU Rowing Spring 2016 Roster

* = Required.

Name

First Name

Last Name

Nickname

First Name

Last Name

SSU Email Address

School ID

Student ID Number

Academic Year

1 = Freshmen, 2 = Sophomore, etc...

Cell Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Phone Number

(###)

###

####

Any pre-existing injuries we should know about (e.g. Sean's Knee)

Please include description of movements that will be impacted based off the injury.

Do you need a payment plan?

Yes

No