SCS Basketball Academy

SCS Academy Basketball Registration

(5-Adult)

Girls & Boys
*Locations

Titusville: 701 South St, Titusville, FL 32780

Viera: 5225 Tavistock Dr. Rockledge, FL 32955

Melbourne: 3410 Flanagan Ave
West Melbourne, FL 32904
* You may choose more than one location, but it will go towards your 6 sessions.
Athlete Information
Player Name *

First Name Last Name
Player Name

First Name Last Name
Player Name

First Name Last Name
Age: *
Age:
Age:
Gender: (Mark Checkbox next to) *

Female Male
Class Schedule

*choose ONE
Titusville

Monday/Wednesday
Ages: 5-8 Time: 5:15pm-6:15pm Ages: 9-15 Time: 6:30-7:30pm
Viera

Tuesday/Thursday
Ages: 5-8 Time: 5:15-6:15pm Ages: 9-15 Time: 6:30-7:30pm
Melbourne

Friday/Sunday CLASS STARTS May 20th
Ages: 5-8 Time: 5:15-6:15pm(Friday Only) Ages: 9-15 Time: 6:30-7:30pm(Friday only) Ages: 5-8 Time: 4:00-5:00pm(Sunday Only) Ages: 9-15 Time: 5:15-6:15pm(Sunday Only)
Shirt Size (check all that apply) *

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:
Parent/Guardian: *

First Name Last Name
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 hondoathletics@gmail.com

SCS Academy Registration *

1 session $ 25.00

Shirt only.

6 weeks $ 125.00

Shirt and Jersey included

Number of Participants

Enter coupon

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

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