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Men's Baseball Player Request Form

Please fill out the following form if you are interested in playing intercollegiate baseball at
Illinois Valley Community College. Please mail this form to:

 

Illinois Valley Community College
Attention: Head Baseball Coach
815 N. Orlando Smith Avenue
Oglesby, Illinois 61348

or email to:  tommy_canale@ivcc.edu

 

Please print or write legibly.

Name:_________________________________________________________________________

 

 Address:_______________________________________________________________________

 

City/State/Zip Code:_______________________________________________________________

 

Telephone with Area Code:__________________________________________________________

 

Cell-Phone/Pager Number:__________________________________________________________

 

E-mail Address:__________________________________________________________________

 

Social Security Number:_____________________________________Date of Birth:_____________

 

Parent's Names:__________________________________________________________________

 

Name of High School:_____________________________________________________________

 

High School Coach's Name:________________________________________________________

 

High School Graduation Date:_______________________________________________________

 

Name of Other Attended College/University (if applicable):_________________________________

 

College/University Coach's Name (if applicable):_________________________________________

Height:                   ____________                   
Weight:                  ____________
Positions Played:    ____________
Bats:                      ____________
Throws:                 ____________

 

Significant Stats/Awards/Honors:______________________________________________________

 

*Please note:  Effective Fall 2013 all student athletes will be required to have primary
health insurance.  If you do not have primary insurance, please contact the Head Coach
and he will give you additional information regarding this matter.