Clone of Midwest Select Registration

Midwest Select Interest Form

Winter 2026-2027 Initial Interest Form
Player Information
New Or Returning Midwest Select Player
Player's Name

First NameLast Name
Birth Date

MonthDayYear
Grade Level For The 2026-2027 School Year
Uniform Size
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Contact Information
Parent's / Guardian Name

First NameLast Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Parent's / Guardian Name

First NameLast Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Commitment
The cost for the winter season is $300, which helps cover gym rental fees, uniforms, and league expenses due at a later date.

Payment plan options are available. If you need a payment plan or have any questions, please contact us at midwestselectyouthbasketball@gmail.com.
Please select the days of the week your player is available to practice.
Does your player have any other obligations or commitments that may overlap with our winter season? If yes, please list those commitments. If not, enter N/A.
Should be Empty:

Midwest Select Interest Form