LJAA Basketball Registration 2025

Child's Name*

First NameLast Name
Grade This Year*
Gender*
Age Now*
Parent / Guardian's Name*

First NameLast Name
Shirt Size
Short Size
E-mail*
Alternate E-mail
Address*

Street Address

Street Address Line 2

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Primary Phone*

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Secondary Phone

Area CodePhone Number
Are you interested in coaching (either head or assist)?*
Do you know of any potential sponsors?*

Sponsor Details

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Company Name
Contact Name
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Doctor Information
Doctor
Doctor's Phone

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Doctor's City
Comments
Pick a Sport

Sport*

Basketball (2nd-7th)$90.00

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