Exclusive Prep Interest Form

Exclusive Prep Interest Form
Player Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Player Email*
example@example.com
Player Date of Birth*
Player Current Age*
Gender*
Player Grade*
School Attending*
Parent Number*

Area CodePhone Number
Parent Email*
example@example.com
Program Interest*

JV Regional TeamVarsity Regional Team (Blue)Varsity Regional Team (White)Varsity National TeamPost Grad
IG Handle (N/A if not applicable)*
Twitter Handle (N/A if not applicable)*
Position (PG,SG, SF, PF, C, Wing)*
Area of Work requiring skills development*
e.g. handling hazardous material, waterproofing, demolition
Thank you for your interest in Exclusive Preparatory Academy. Someone will reachout to you to schedule a call. Please click the submit button to process your request.
Player Level of Experiencing Playing Basketball*
Please elaborate on the players experience listing any teams they have previously played on. If no experience, please put "N/A"*
Please provide a good contact name, phone number, and time to call you to discuss joining Exclusive Prep. Please include the time zone.*
Should be Empty: