5Star/MBA Select Training Registration
Player Information
Player Name
*
First Name
Last Name
Preferred Name (if applicable)
Gender
*
Please Select
Female
Male
Grade
*
Please Select
4th
5th
6th
7th
8th
9th
10th
11th
Is your player registered with 5 Star/MBA Select this season?
*
YES
NO
Select your Training Preferences
Mondays 4:30-5:30
Mondays 5:30-6:30
Wednesdays 4:30-5:30
Wednesdays 4:30-5:30
Saturday 10:00-11:00
Saturday 11:00-12:00
Parent/Guardian Information
Parent/Guardian
*
First Name
Last Name
Phone Number
*
Parent/Guardian E-mail
*
Emergency Contact
*
First Name
Last Name
Emergency Contact Number
*
Relationship to Student
Liability Release
My Products
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1 hr. Private 1-on-1 Session
$
60.00
Quantity
Group Sessions (1 hr)
$
40.00
Quantity
Donate to Player Scholarship Fund
$
50.00
Quantity
Enter coupon
Apply
Total
$
0.00
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Parent/Guardian Signature
*
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