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

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