GVBA Summer Skill Development Registration

Going Vertical Basketball Academy

Summer Skill Development Program - Registration
Athlete Information
Athlete's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*

Area CodePhone 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 PM to 9:00 PM)
Nights (Select Two Nights)*

MondayTuesdayWednesdayThursday
Payment*
prevnext( X )
New Client Registration (2 Nights)$320.00

Returning Client Registration (2 Nights)$280.00

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.
Should be Empty: