8/9 Year Old Basketball Registration
Primary Parent Name
*
First Name
Last Name
Primary Parent Email
*
example@example.com
Primary Parent Phone
*
-
Area Code
Phone Number
Primary Parent Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Parent Name
First Name
Last Name
Secondary Parent Email
example@example.com
Secondary Parent Phone
-
Area Code
Phone Number
Do You Currently Attend A Church?
*
Yes
No
What Church Do You Attend?
Child Information
Name of Child Participant
*
First Name
Last Name
Child Date Of Birth
*
-
Month
-
Day
Year
Child must be at least 8 years old by January 1, 2020 and Cannot Be Age 10 Before January 1, 2020
Gender Of Child
*
Male
Female
Child T-Shirt Size
*
XS
S
M
L
XL
Adult S
Adult M
Child Shorts Size
*
Child XS
S
M
L
XL
Adult S
Adult M
Does Your Child Have Any Medical Or Allergy Related Concerns?
*
Yes
No
Please describe the Medical Or Allergy Related Concern(s)
Emergency Contact Information
Primary Emergency Contact
*
First Name
Last Name
Primary Emergency Contact Phone
*
-
Area Code
Phone Number
Alternate Emergency Contact
First Name
Last Name
Alternate Emergency Contact Phone
-
Area Code
Phone Number
Registration Fee = $85.00
Registrations fee covers uniform, referees and end of year celebration expenses
*
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( X )
2019 Season Registration
$
85.00
Total
$
0.00
Signature (Sign with finger, stylus or mouse)
*
Proceed To Checkout
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