Higher Intentions: Fall Basketball

Higher Intentions

Fall Basketball Season: Aug - Oct
Athletes Information

Personal & Medical
Name:*

First NameLast Name
Birthdate:*

MonthDayYear
Grade (Entering This Fall):*
Jersey # (First come basis):*
Uniform Size:*

Youth MediumAdult MediumYouth LargeAdult LargeAdult SmallAdult X-Large
Athletes Phone Number (If Applicable):

Area CodePhone Number
List Any Allergies and Dietary Restrictions:
Medications & Frequency (if needed)
Any Other Medical Information:
Parent / Guardian Information

(All correspondence and invoices will be sent to this person)
Name:*

First NameLast Name
Email:*
example@example.com
Cell Phone:*

Area CodePhone Number
Work Phone:

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Athlete:*
Parent 2/ Guardian 2 Information (Optional)

(All correspondence and invoices will be sent to this person)
Name:

First NameLast Name
Email:
example@example.com
Cell Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Athlete:
Emergency Contacts and Authorized Pick Up Persons: (At Least One)*
Payment

Please Send Payment to @HigherIntentions - via Venmo
Fall Basketball Season:

$1,799
Terms & Conditions
I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY AND UNDERSTAND ITS TERMS. I SIGN IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS LEGAL SIGNIFICANCE.
Date:*

MonthDayYear
Signature:*

Powered by Jotform SignClear
Should be Empty:

Higher Intentions

Athletes Information

Parent / Guardian Information

Parent 2/ Guardian 2 Information (Optional)

Payment

Terms & Conditions