Student/First Responder Basketball Game Sign Up

Students VS. First Responders Basketball Game

Hosted by La Pine Community Health Center
Name

First NameLast Name
How old are you? (Must be 12 or older)
Which school do you attend?

La Pine Middle SchoolLa Pine High SchoolGilchrist High SchoolNorth Lake High SchoolThree Rivers SchoolOther
T-Shirt Size
A parent/guardian will need to sign a permission form before game day. Please provide the name of a parent/guardian along with a phone number and email address. In case of any changes, we will attempt to contact you by phone and email.
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Parent/Guardian Email Address
example@example.com
Should be Empty:

Students VS. First Responders Basketball Game