Anthony Ray's Recruiting Academy

Anthony Rays Recruiting Academy Registration Form
Full Name
Date of Birth MMDDYYYY

MonthDayYear
Date
Age
Grade Level
School Name
Height
Position (Guard, Forward or Center)
Full Name
Phone Number

Area CodePhone Number
Email Address
example@example.com
Emergency Contact Name Number
AAU Club Team if applicable
Coachs Name
Coach's Contact (Phone/Email)

Area CodePhone Number
Years of Basketball Experience
Preferred Start Date

MonthDayYear
Date
Anthony Rays Recruiting Academy
Acknowledgment & Consent

I, the undersigned, hereby certify that all information provided is accurate to the best of my knowledge. I agree to allow my child to participate in the Arizona Preps Basketball Recruiting Academy and authorize the use of their photos/videos for promotional purposes.
Signature of ParentGuardian

Clear
Date

MonthDayYear
Date

My Products

Per Session1 session

$100.00 Quantity

Monthly4 sessions

$350.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Anthony Rays Recruiting Academy