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PVCA ALL-STAR QUESTIONNAIRE

Name_______________________ High School_______________________

Address____________________________ Phone ( )_________________

____________________________

(zip code)

Academic Honors (Please list no more than 3)

_______________________________________________________________________________________________________________________________________________________________________________________

Athletic Honors (Please list no more than 3)

College you plan to attend

(or other plans – employment, military, etc.)

Major area of study

Height Position

Sweatshirt size (check one) Large XL XXL

Please return this form and the attached waiver form IMMEDIATELY to John C. Baranowski, 336 Blueberry Hill Rd., Shavertown, Pa. 18708.