2022-23 Optimist Basketball Form

Parent Information, Coach & Payment
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail *
Parent/Guardian Name

First Name Last Name
Phone Number

Area Code Phone Number
E-mail
Willing to Coach or Assist?
Coach's Name:
Coaches Name
Coach's Shirt Size
Coach
REGISTRATION PAYMENT
The cost is $40 per player for 1st-2nd grade players and $55 per child for 3rd-6th grade players. Registration is due by November 1st. If interested in registering after November 1, please contact AshlandOptimistBasketball@gmail.com to find out if there is space available.

For scholarships, please email AshlandOptimistBasketball@gmail.com to receive a coupon code before completing registration. If you are registering more than two players from the same family, please email to request a coupon code.

1st-2nd Grade Registration $ 40.00

Number of players registering

3rd-6th Grade Registration $ 55.00

Number of players registering

Enter coupon

Total $ 0.00

I acknowledge that basketball is a sport that requires physical exertion and has some risk of injury. I have no concerns about my child’s ability to handle the level of activity necessary to play basketball. The child or children named above has/have my permission to participate in the Optimist basketball program.

Consent to Treat

I hereby give my consent to the above applicant treated by a physician or surgeon in case of sudden illness or injury while participating in the above event.

By clicking submit I have read and understood the foregoing registration form, liability release form, parental consent and consent to treat, and agree to all their terms and conditions.
Once you click "Submit Form" below, you will be taken to a secure PayPal site to complete your payment. Ashland Optimist Soccer is a PayPal verified merchant. You may pay by credit card or PayPal account.
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Ashland Optimist Basketball