Basketball Tryout Registration

TYLER JUNIOR COLLEGE Basketball
Registration Form

Please fill out the secure online registration form below for each athlete. Following submission, you will be redirected to make payment for the tryout fee through our online payment portal. The athlete's spot will only be reserved upon receipt of payment. If you have any questions, please feel free to contact us at Brandon.taylor@tjc.edu.

Athlete Information

Athlete's Full Name

First NameLast Name

School Grade/Team

Athlete's Age

Current School Attending

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Full Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions that would limit high level activtiy?

Please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Please explain any instructions.

Confirmation

By entering the information 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.

Parent/Guardian Full Name

First NameLast Name

Parent/Guardian Signature

Confirmation E-mail