GVBA Winter Skill Development Registration

Going Vertical Basketball Academy

Winter Skill Development Program - Registration
Athlete Information
Athlete's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*

Area CodePhone Number
Age Group*

K - 2nd Grade at GVBA (5:00 to 6:00 PM)3rd/4th Grade at GVBA (5:00 to 6:00 PM)5th/6th Grade at GVBA (6:00 to 7:00 PM)7th/8th Grade at GVBA (7:00 to 8:00 PM)
Nights/Days (Select One or Two depending on registration package)*

MondayTuesdayWednesdayThursday
Skill Level (We will adjust according to what we feel is appropriate for each individual athlete)

Beginner to Average ExperienceAbove Average to Advanced Experience

Payment*

12-Week Registration (2 Nights)$480.00

12-Week One Night Registration$250.00

Session 1 (First 6-Weeks)$250.00

Session 2 (Second 6-Weeks)$250.00

Enter coupon

Subtotal $0.00Tax $0.00Total $0.00

Confirmation

BY ACKNOWLEDGING AND SIGNING 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.
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