PREMIUM PREP ACADEMY
4TH GRADE BOYS BASKETBALL | WINTER 2027
PARENT / GUARDIAN REGISTRATION FORM
MSYS | Season begins January 9, 2027 | 6 games | $200 per player
Registration only. No payment is collected with this form.
PLAYER INFORMATION
Player full name *
*
First Name
Last Name
Current grade *
*
Date of birth (MM/DD/YYYY) *
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current school *
*
Basketball experience (select one):
Beginner
Recreational league
School team
AAU / Travel
Other
PARENT / GUARDIAN INFORMATION
Parent / guardian full name *
*
First Name
Last Name
Relationship to player *
*
Phone number *
*
Format: (000) 000-0000.
Email address *
*
example@example.com
City / ZIP code *
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred contact method:
Call
Text
Email
ADDITIONAL INFORMATION
Goals for your child (optional)
Questions or comments (optional)
Parent / guardian acknowledgment *
*
I am the parent/legal guardian and agree to be contacted about this program.
I understand the $200 player fee is separate from submitting this registration.
Parent / guardian signature (type name) *
*
Date *
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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