Surge Fall/Winter 2026 Registration Form

Surge Registration Form

Thank you for your interest in Surge Basketball! Please complete the information below to help us provide a safe and enjoyable experience for all athletes. The information collected will be used for registration and emergency purposes, medical considerations, and essential communications only. We are excited to help your athlete develop their skills, build confidence and, most importantly, have a fun and positive experience.
Athlete Information
Athlete's Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Grade
Skill Level
Program / Camp Selections
Program/Camp Option
Age Division Selection

Please select the age division that your athlete is trying out for. You can select a max of two (ie. if trying out for U14 or U13).
Parent/Guardian Information
Parent/Guardian Full Name

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

First NameLast Name
Relationship to Child
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical/Wellness Information
Child's Medicare Number
Does the athlete have any medical conditions (or take any medications) we need to be aware of?
Does the athlete have any allergies?
Does the athlete have any additional medical requirements/support needs? Is there anything that may make them nervous or anxious?
Is there anything else you would like us to know about your athlete?
PAYMENT LINKS & INFORMATION

Fall/Winter Registration Tryout Fee: Pay here

If parents prefer, email transfers are permitted. EMT's can be sent to surgebasketballacademy@hotmail.com

For Surge Camps only - A $50 deposit is required per camp at the time of registration. Please note that the price listed includes a $5 online processing fee per camp.

Payment is required in full the day prior to camp (unless prior arrangements have been made directly with Surge Owner Tony Battilana).
Payment Option
Media Permissions
Photos on social media
Videos for promotional purposes
Participant Waiver and Release of Liability

I, the undersigned parent/legal guardian, acknowledge that participation in Surge Basketball camps and/or programs involve inherent risks (including but not limited to falls, collisions, physical exertion, and other incidents that may result in injury, illness, or property damage). In consideration of my child being permitted to participate in Surge Basketball programming, I voluntarily assume all risks associated with their participation and release, waive, and discharge Surge Basketball from any and all claims, liabilities, demands or actions, arising from any loss, injury, illness, or damage that may occur during participation (except where caused by gross negligence or willful misconduct). I confirm that my child is physically able to participate in basketball activities and that I have disclosed any relevant medical conditions, allergies, medications, or special considerations that Surge should be aware of. In the event of an emergency, I authorize Surge Basketball to obtain necessary medical treatment for my child if I cannot be reached immediately. By checking this box and submitting this registration, I acknowledge that I have read, understood, and agree to the terms of this waiver and release on behalf of myself and my child.
Parent/Guardian Signature
Should be Empty: