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PRE-REGISTRATION FORM

Profile Data

Name: ____________________________ Age:_____ Skill/Event:_______________

Birthdate:___________ Place of Birth:_________________________

Sports and Dance:________________ Highest Level of Participation:_________________

Award Received:___________________ Medical Condition: _________(Yes or No)
___________________ If yes, specify: __________________
___________________

PHYSICAL FITNESS TEST FORM

Exercise
BEEP TEST Score Remarks Evaluator Signature
Agility Illinois
Run

Push up

Curl ups

Skill Test
Sports

Dance

Music

Name and Signature