Belton Blaze Player Registration Form

Belton Blaze Player Registration Form
Registration Fee: $550 per player (2 siblings - $495, 3 siblings - $475)

Please Complete one form per player.

* A copy of the most recent report card must be submitted by ALL players.

* At least half of the registration fee ($275) must be paid once the selection letter has been sent. The remaining balance will be paid on 15 May 2026. Payment arrangements can be made. (Players may practice but will not be allowed in a game until payment is confirmed).

* Parents and players must sign the Parent and Player handbook.
Player Full Name*

First NameLast Name
Player Date of Birth*

MonthDayYear
Date
Player Grade as of February 2026*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 Full Name*

First NameLast Name
Parent/Guardian 1 Phone Number*
Format: (000) 000-0000.
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 2 Full Name

First NameLast Name
Parent/Guardian 2 Phone Number
Format: (000) 000-0000.
Parent/Guardian 2 Email
example@example.com
Please list any medical conditions or injuries.*
I/We, the parents of the above Player, hereby give approval for her to participate in any/all activities of the program during the current season.

I/We assume all the risks and hazards incidental to the activities and transportation to and from activities. I/We further hereby release, absolve, indemnify, and hold harmless Belton Blaze Basketball, the organizers, the coaches, or any other supervisors appointed by them. I/We likewise release from liability any person transporting my/our child to or from any activities.

My signature below acknowledges my undertanding of this paragraph and all requirements of Belton Blaze Basketball.
Signature*
Should be Empty: