Second Wind Private Lesson Registration Form

Welcome to the Second Wind Basketball Academy registration form. Please complete the form below to register for Private Lessons. We look forward to working with you!
PLAYER STATUS
Have you trained with Second Wind before?
CHOOSE DATE AND TIME
Choose Your Session Time(s)
PLAYER INFORMATION
Player First Name
Player Last Name
Date of Birth

MonthDayYear
Date
Grade Entering Fall 2026
School Attending
Gender

Other
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name
Relationship to Player
Email Address
example@example.com
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Emergency Contact
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
MEDICAL INFORMATION
Does the participant have any allergies?
Does the participant have any medical conditions?
Additional Medical Notes
MEDICAL AUTHORIZATION
Please read and review the Medical Authorization Statement
I have read and agree with the Medical Authorization Statement
LIABILITY WAIVER
Please read and review the Liability, Risk, and Assumption Waiver
I have read and agree with the Liability, Risk, and Assumption Waiver
CODE OF CONDUCT
Please read and review the Code of Conduct
I have read and reviewed the Code of Conduct with my player
SELECT A PLAN / PAYMENT
Payment Options
How would you like to pay?
Venmo Payment Instructions

Please send your payment to @CoachTJohnson

In the payment note, include:
- Player's Name
- Parent's Last Name
- Discount Code if applicable
Your registration is not complete until payment has been received.

Should be Empty:

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Enter coupon

PLAYER STATUS

CHOOSE DATE AND TIME

PLAYER INFORMATION

PARENT/GUARDIAN INFORMATION

MEDICAL INFORMATION

MEDICAL AUTHORIZATION

LIABILITY WAIVER

CODE OF CONDUCT

SELECT A PLAN / PAYMENT

Payment Options