SOUTHSIDE CHARGERS WAITING LIST FORM
Player Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Gender
*
Male
Female
School
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Basketball experience
*
Is your child in a WABL team?
Yes
No
If Yes, which age group and division?
U12 Championship
U12 Division 2
U12 Division 3
U12 Division 4
U14 Championship
U14 Division 2
U14 Division 3
U14 Division 4
U16 Championship
U16 Division 2
U16 Division 3
U16 Division 4
U18 Championship
U18 Division 2
U18 Division 3
U18 Division 4
Previous Sporting Experience
*
Does the child have a parent or family member who is willing to Coach or Manage a team?
Please Select
Coach
Manage
Unable to help
How did you hear about us (Please name if recommended by a friend)
Comments:
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