Goalkeeper Intake Form

NEW GOALKEEPERS

GOALKEEPER
INTAKE FORM

Fill this in before your first session so Coach Jerimy can plan the right starting point for your keeper.

Takes about two minutes. Everything you share stays with Just4GK.

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A LITTLE CONTEXT HELPS US START in the right direction

Required fields are marked with an asterisk. If you are filling this in for your keeper, answer from the parent or guardian’s perspective.

SECTION 1 — GOALKEEPER INFORMATION

Welcome to Just4GK. Before your first session, we'd love to learn about your goalkeeper and your family. This form helps Coach Jerimy understand where your keeper is today, what matters most to you, and how to make every session as impactful as possible. There are no right or wrong answers, just honest ones.

Goalkeeper's Full Name

Date of Birth

Month

Day

Year

Age

Grad Year

School Name

Current Club Team

Team Level / League

Height

Weight (optional)

Dominant Hand

Right

Left

Dominant Foot

Right

Left

Gender

Male

Female

Prefer not to say

SECTION 2 — PARENT / GUARDIAN INFORMATION

Parent/Guardian Name

If 'Other', describe your relationship to the goalkeeper

Primary Phone

Email Address

Preferred Contact Method

Text

Call

Home City

Zip Code

SECTION 3 — GOALKEEPER EXPERIENCE & BACKGROUND

How long have they been playing goalkeeper?

Less than 1 year

1-2 years

3-4 years

5+ years

How did they come to play goalkeeper?

Their choice

Coach placed them

Parent suggestion

Tried it and loved it

Do they play any other positions? (list them)

Have they had GK-specific coaching before Just4GK?

No - first specialized GK training

Yes - with a private coach

Yes - through a club program

Yes - camps or clinics only

If yes, describe briefly

Soccer clubs or teams played for (most recent first) — name, level/league, years played, GK or field, one per line

Do they play any other sports? (list)

How many days/week training or playing soccer?

1-2

3-4

5-6

Every day

SECTION 4 — THE GOALKEEPER ANSWERS THIS SECTION

Hey goalkeeper, this part is for YOU. Answer in your own words. There are no wrong answers and Coach Jerimy reads every single one.

What is your name and how old are you? Tell us a little about yourself.

Why do you play goalkeeper? What do you love about the position?

YOUR STRENGTHS — WHAT YOU DO WELL (Technical): Check everything you feel confident in. Be honest — this helps us build on what you already have.

YOUR STRENGTHS — WHAT YOU DO WELL (Mental & Physical): Check everything you feel confident in.

AREAS FOR DEVELOPMENT — WHERE YOU WANT TO GROW (Technical): Check the areas you know you need to work on. Check as many as you want — this is not a test, it's a starting point.

AREAS FOR DEVELOPMENT — WHERE YOU WANT TO GROW (Mental & Physical): Check the areas you know you need to work on.

GOALS & EXPECTATIONS: What is your #1 goal for training at Just4GK?

Where do you want to be as a goalkeeper 1 year from now?

Is there anything about training or playing goalkeeper that makes you nervous or that you want to work through?

What is the best thing a coach has ever said or done that helped you?

What do you do outside of soccer? (hobbies, interests, other sports)

Is there anything else you want Coach Jerimy to know about you?

SECTION 5 — THE PARENT / GUARDIAN ANSWERS THIS SECTION

This section helps Coach Jerimy understand your perspective, your expectations, and how to best communicate with your family throughout training.

From your perspective, what are your goalkeeper's greatest strengths right now?

What areas do you most want to see them develop through Just4GK training?

How would you describe your goalkeeper's personality and attitude toward training?

Anything else that describes them well

How does your goalkeeper typically respond after making a mistake in a game?

What is your primary goal in enrolling at Just4GK?

Improve their technical GK skills

Build their confidence

Prepare for high school soccer

Pursue college recruitment

Develop their mental resilience

Fill a gap their club program doesn't cover

Keep them active and developing year-round

Other

If 'Other', please describe your primary goal

What does success look like for your goalkeeper at the end of their first 12-week block?

Do you have any concerns or questions going into training that you'd like Coach Jerimy to address?

How often would you like progress updates from Coach Jerimy?

What format do you prefer for updates?

Text message

Brief in-person chat after session

Written report or form

HEALTH, SAFETY & LOGISTICS: Does your goalkeeper have any medical conditions, injuries, or physical limitations Coach Jerimy should be aware of?

No - none at this time

Yes - please describe below

If yes, please describe the medical condition, injury, or limitation

Any allergies (food, environmental, medication) we should be aware of?

None known

Yes - please describe

If yes, please describe the allergy

Emergency Contact Name (if different from above)

Emergency Contact Number (If different from above)

If 'Other', describe the emergency contact's relationship to the goalkeeper

If 'Other', how did you hear about us?

If referred by someone, who can we thank?

SECTION 6 — ACKNOWLEDGMENT & SIGNATURE

By signing below, you confirm that the information provided is accurate to the best of your knowledge, and that you have read and understood Just4GK's session policies, including the 24-hour cancellation/reschedule policy for training sessions and weather-related cancellation protocols.

I have read and agree to the above

Parent/Guardian Full Name

Date

Month

Day

Year

Goalkeeper Full Name

Date

Month

Day

Year

NEW GOALKEEPERS

GOALKEEPER INTAKE FORM

A LITTLE CONTEXT HELPS US START in the right direction

GOALKEEPER
INTAKE FORM