Youth Basketball Registration Form

YOUTH BASKETBALL REGISTRATION FORM

~ COMPLETE ONE FORM PER CHILD ~

Please email completed form to:

Player's Name: _______________________________________________________

Player's Age: _______ Incoming Grade: __________

Parent's/Guardian's Name: _______________________________________________

Address: ________________________ City: ________________ Zip:_____________

Email: _______________________________________________________________

Phone 1: ______________________ Phone 2: ______________________________

Please circle one

Gender:

Male

Female

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IN CASE OF EMERGENCY

Contact 1

Contact 2

Name: ___________________________

Name: _____________________________

Phone: ___________________________

Phone: ____________________________

Relationship: ______________________

Relationship: ________________________

Please email completed form to:

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Parent category: Life