Winter 2023 Basketball Clinic Registration
Name Of Child
*
First Name
Last Name
Name of Primary Parent / Guardian
*
First Name
Last Name
Primary Parent / Guardian Mobile Phone
*
Please enter a valid phone number.
Primary Parent / Guardian Email
*
example@example.com
Name of Secondary Parent / Guardian
*
First Name
Last Name
Secondary Parent / Guardian Mobile Phone
*
Please enter a valid phone number.
If anyone other than the adults above are authorized to pick up your child, list the name(s) here:
Submit
Should be Empty: