Player Registration Form

Player Registration Form
Season Dates: Nov. 8th/15th/22nd & Dec. 6th/13th/20th
REGISTRATION OPEN SEPT. 1ST-30TH, 2026

- Please fill out one form per player -
Player Name

First NameLast Name
Child's D.O.B

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Age:
School:
Grade:
Gender:
Division:
Coach Request:
Coach Name
I would like to coach:
Name of Parent to Coach
Shirt Size: Jerseys provided to be returned at the end of season
Parent Name

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
l do hereby release Blackwell Basketball Boosters, its coaches, and Blackwell Public Schools and its employees that be associated with Blackwell Youth Basketball League, from any and all liability, related to any incident or injury that may occur as a result of my child's participation in the Blackwell Youth Basketball League. I further agree to do pursue any legal action against the above names entities, nor its board members, coaches and employees, and I agree to provide proper insurance for my child.
Type Your Name as Signature

Player Entry Fee

Per Player

$35.00

Credit Card

Apple Pay

Google Pay

Cash App Pay