Basketball Registration Form

SURGE Athlete TRYOUT Information

TRYOUT DATES WILL BE LAST WEEK OF FEBRUARY

A tryout fee of $25 can be sent to

Surgebasketballpayments@gmail.com
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SURGE BASKETBALL spring/Summer Tryouts U11 to U18 Girls and Boys Teams
Player Name*

First NameLast Name
Guardian / Parents Names*

First NameLast Name
Age as of now & Grade as of next year*
Please State which age division player will be trying out for. example U11Girls
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Cell Phone
E-mail*
example@example.com
Basketball skill level*

1

2

3

4

5

1 is Begginer, 5 is Advanced
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo
Please describe*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Parent's Signature/ Child's Signature*
Should be Empty:

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