SPRING HOOPS

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SPRING BASKETBALL Youth INFORMATION Name:*

SPRING BASKETBALL Youth INFORMATION Name: Date of Birth

Age

Street Address

Apt#

City

State

Zip Code

Home Phone

Youth Cell Phone

Gender

MaleFemale

Is Your Child A Returning Youth

YesNO

Current School

Current Grade Level

PARENT GUARDIAN INFORMATION Name:

Relationship to Participant

Street Address

Apt #

City

State

Zip Code

Home Phone

Cell Phone

List additional persons authorized to pick up my child at the end of each day or emergency

Please be advised new persons picking up child may be required to present ID Employer (if unemployed, write "None")

Work Phone

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SPRING BASKETBALL PROGRAM REG.

$60.00

PLEASE NOTE REGISTRATION WILL NOT BE CONFIRMED WITHOUT PAYMENT

$65 dollars.$15 Optional Tshirt