Space Coast Stars Jr. Magic League Camp

Space Coast Stars Jr. Magic League Academy Registration

(5-13)

Youth Sport Center - 2955 Minton Road, West Melbourne, FL 32904

spacecoaststarsbasketball@gmail.com

Athlete Information

Name of Participant: *

First Name Last Name

Age: *

Gender: (Mark Checkbox next to) *

Female Male

Grade: *

Has participant played on a basketball team before? *

Yes No

Jersey Size (check one): *

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large

Medical Information:

Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy? *

Yes No

Parent/Guardian Information:

Guardian / Parents Names: *

First Name Last Name

Home Phone: *

Area Code Phone Number

Cell Phone:

Area Code Phone Number

E-mail: *

Emergency Contact

Emergency Contact's Name: *

First Name Last Name

Phone Number: *

Confirmation

Signature *

Clear

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at spacecoaststars@gmail.com.

Magic League Summary

Jr. Magic League 4 sessions $ 85.00

Jr. Magic League 8 sessions $ 160.00

Jr. Magic League 12 sessions $ 235.00

Jr. Magic League 15 sessions $ 320.00

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Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00