Premier Youth Bowling Registration
Bowlium Lanes - 4666 Holt Blvd., Montclair, CA. 91763 - Saturdays at 11:00 AM
Today's Date
*
/
Month
/
Day
Year
BOWLER'S NAME
*
First Name
Middle Initial (strongly recemmended)
Last Name
AGE
*
BIRTHDATE
*
-
Month
-
Day
Year
Date Picker Icon
GENDER
*
MALE
FEMALE
USBC MEMBERSHIP #
HAND USED FOR BOWLING
*
RIGHT
LEFT
TWO HANDED (RIGHT)
TWO HANDED (LEFT)
BOWLING EXPERIENCE
*
NEW BOWLER
UNDER 1 YEAR
1-3 YEARS
+3 YEARS
ARE THERE INJURIES OR PHYSICAL LIMITATIONS THAT MAY AFFECT THIS BOWLER'S ABILITY TO BOWL INDEPENDENTLY?
*
YES
NO
If YES explain:
PARENT/GUARDIAN INFORMATION
*
First Name
Last Name
PRIMARY PHONE #
*
Please enter a valid phone number.
Format: (000) 000-0000.
ADDRESS: (PO BOX NOT ACCEPTED)
*
Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PRIMARY EMAIL
*
example@example.com
I authorize bowling photos of my son/daughter to be taken/posted on the league website and/or newsletter.
*
YES
NO
NAME OF BOWLER(S) YOU'D LIKE TO BE ON YOUR BOWLER'S TEAM:
TYPE ANY QUESTIONS OR COMMENTS FOR THE YOUTH PROGRAM DIRECTOR BELOW:
ALTERNATIVE PHONE # (RECOMMENDED)
Please enter a valid phone number.
Format: (000) 000-0000.
ALTERNATIVE EMAIL (OPTIONAL)
example@example.com
PARENT/GUARDIAN SIGNATURE
*
Submit
Should be Empty: