Athlete Name
*
Parent Name
*
Birthdate (mm/dd/yyyy)
*
Phone Number
*
Gender
Male
Female
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Grade in School
*
Name of School
*
Email
*
Which CA Storm Season are you registering for?
*
8u-14u Fall (August 26-November 3)
High School Boys (August 26-October 31)
High School Girls (August 26- October 31)
Basketball Position
*
Do you have any allergies, chronic illness or medical condition that would limit high level activity? Please describe.
Name of Physician/Emergency Care Facility
Medical Provider Phone Number
Please enter a valid phone number.
Date
*
-
Month
-
Day
Year
Signature
*
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