Athlete Intake — Quantum Leap Sports Agency

Personal Information

First Name*

Last Name*

Date of Birth*

Preferred Contact Method*

Email Address*

Phone Number*

Street Address*

City*

State*

ZIP Code*

Parent / Guardian Contact Required if you are under 18. Optional otherwise.

Parent / Guardian Name optional

Parent / Guardian Phone or Email optional

Athletic Profile

Sport*

Position / Event optional

High School Attended*

College / University if applicable

Class Year*

NCAA Eligibility Years Remaining optional

GPA / Academic Standing optional

Current Representation

Are you currently represented by an agent?*

Yes No

If yes, which agent or firm represents you?

NIL & Social Presence Helps us understand your current reach — all optional.

Current NIL Deals or Sponsorships optional

Emergency Contact

Emergency Contact Name*

Emergency Contact Phone*

A Little More

How did you hear about QLSA? optional

What are you hoping for from representation? optional

Consent & Signature

I certify that the information provided above is accurate to the best of my knowledge.

I understand that submitting this form is an inquiry only and does not, by itself, create any representation, agency, or contractual relationship with Quantum Leap Sports Agency.

Typed Signature (Full Name)*

Date*

Every submission is read personally by the QLSA team. We typically respond within a few business days.

This form collects information for evaluation purposes only. It is not a legal contract and does not establish representation. If your submission moves forward, any formal agreement will be provided separately for review — we recommend you have any contract reviewed by a trusted advisor or attorney before signing. QLSA does not sell or share your information with third parties.

✓

Thank you.

Your intake has been received. A member of the QLSA team will be in touch personally.

Tell us who you are — we'll take it from there.

Thank you.