Lox Legacy Basketball League Registration

Lox Legacy Basketball League Registration
Participant's Full Name

First NameLast Name
Participant's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Participant's Gender
Player Position
Player Height
Player Skill Level
Available Practice Days - All games on Saturdays
I authorize the league to use photos/videos of my child for: Website Social Media Marketing League Publications
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the participant have any allergies or medical conditions?
Jersey Size
Signature
Please contact me about:
My Products
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Fall Season
Sept. 5 - Oct. 17

$200.00

Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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