Fields marked with * are mandatory
General

First Name *
*Please enter valid First Name
Last Name *
*Please enter valid Last Name
Email Address
*Please enter valid Email Address
Home Address1
*Please enter valid Home Address1
Home Address2
*Please enter valid Home Address2
City
*Please enter valid City
State
*Please enter valid State
Zip
*Please enter valid Zip
Contact Number
*Please enter valid Contact Number
Cell Phone Number
*Please enter valid Cell Phone Number
Graduation Year
*Please enter valid Graduation Year
Position






*Please enter valid Position
Background

Mother's Name
*Please enter valid Mother's Name
Mother's Phone Number
*Please enter valid Mother's Phone Number
Mother's Email
*Please enter valid Mother's Email
Father's Name
*Please enter valid Father's Name
Father's Phone Number
*Please enter valid Father's Phone Number
Father's Email
*Please enter valid Father's Email
Date of Birth.
*Please enter valid Date of Birth.
Screen Name
*Please enter valid Screen Name
Bethany Students/Alumni you know
*Please enter valid Bethany Students/Alumni you know
Athletic

Sports you played in high school
*Please enter valid Sports you played in high school
Sports you wish to play in college
*Please enter valid Sports you wish to play in college
Athletic Letters earned
*Please enter valid Athletic Letters earned
Athletic honors/awards
*Please enter valid Athletic honors/awards
High School Coach
*Please enter valid High School Coach
HS. Coach's Email
*Please enter valid HS. Coach's Email
HS. Coach's Phone Number
*Please enter valid HS. Coach's Phone Number
Club Coach
*Please enter valid Club Coach
Club Coach's Phone Number
*Please enter valid Club Coach's Phone Number
Club Coach's Email
*Please enter valid Club Coach's Email
50 yd. Freestyle Time
HHMMSECMSEC
*Please enter valid 50 yd. Freestyle Time
100 yd. Freestyle Time
HHMMSECMSEC
*Please enter valid 100 yd. Freestyle Time
200 yd. Freestyle Time
HHMMSECMSEC
*Please enter valid 200 yd. Freestyle Time
500 yd. Freestyle Time
HHMMSECMSEC
*Please enter valid 500 yd. Freestyle Time
1000 yd. Freestyle Time
HHMMSECMSEC
*Please enter valid 1000 yd. Freestyle Time
1650 yd. Freestyle Time
HHMMSECMSEC
*Please enter valid 1650 yd. Freestyle Time
100 yd. Backstroke Time
HHMMSECMSEC
*Please enter valid 100 yd. Backstroke Time
200 yd. Backstroke Time
HHMMSECMSEC
*Please enter valid 200 yd. Backstroke Time
100 yd. Breaststroke Time
HHMMSECMSEC
*Please enter valid 100 yd. Breaststroke Time
200 yd. Breaststroke Time
HHMMSECMSEC
*Please enter valid 200 yd. Breaststroke Time
100 yd. Butterfly Time
HHMMSECMSEC
*Please enter valid 100 yd. Butterfly Time
200 yd. Butterfly Time
HHMMSECMSEC
*Please enter valid 200 yd. Butterfly Time
200 yd. Individual Medley Time
HHMMSECMSEC
*Please enter valid 200 yd. Individual Medley Time
400 yd. Individual Medley Time
HHMMSEC