Pre-Register Form

Player Name:
 
Address:
 
City/State/Zip:
 
Home Phone:
 
Cell Phone:
 
Email:
 
School:
 
Grade:
 

Birthdate:

 

 

 

Parent/Guardian #1 :
 
Home Phone:
 
Cell Phone:
 

Email:

 

 

 

Parent/Guardian #2 :
 
Home Phone:
 
Cell Phone:
 

Email:

 

 

 

# of Years Played:
 
Position:
 
Team Name:
 
Outside Sports - Any sport that will conflict with basketball (i.e. volleyball, softball, track, etc), please be specific: