GVBA Fall Skill Development Registration

Going Vertical Basketball Academy

Fall Skill Development Program - Registration
Athlete Information
Athlete's Name

First Name Last Name
Birth Date

Month Day Year
Gender

Male Female
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number

Area Code Phone Number
Age Group

K - 2nd Grade (5:00 to 6:00 PM) 3rd - 5th Grade (6:00 to 7:00 PM) 6th - 8th Grade (7:00 to 8:00 PM) High School (8:00 to 9:00 PM)
Nights (Pick TWO)

Monday Tuesday Wednesday Thursday
Payment
prev next ( X )
New Client Registration $ 280.00

Returning Client Registration $ 260.00

Total $ 0.00
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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