2027 K-1 Children's Basketball Season

2027 K-1 Children's Basketball Season

Deadline for fee and registration is November 15, 2026. Please complete the registration, consent, payment, and coaching interest information below. This sign up is ONLY for K-1st graders.
Player Information
Child's Name

First NameMiddle NameLast Name
Gender
Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Grade
Child School
Allergies or medical conditions
Jersey Size
Parent / Guardian Information
Parent / Guardian Name

First NameMiddle NameLast Name
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Second Parent / Guardian Name

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

First NameMiddle NameLast Name
Emergency Contact Relationship
Emergency Contact Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Consent and Signature
I, as a parent/guardian, grant permission for my child to participate in the above program and release Vinton Baptist Church or any other church facilities and the coach(es) from any liability for damages, or injuries which might be incurred during the operation of this program. I assure that a physician prior to participation has examined my child. In the event I cannot be reached, I give permission for my child to receive emergency meidcal care. I verify that the above is true and complete to the best of my knowledge.
Parent/Guardian Signature
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Payment and Coaching Interest
A registration fee of $55 is due at time of sign up. I will make payment via
Coaching Interest

Other
Any Additional Comments
Should be Empty:

2027 K-1 Children's Basketball Season

Player Information

Parent / Guardian Information

Emergency Contact Information

Consent and Signature

Payment and Coaching Interest