Player Registration

1

Parent or Guardian

Primary contact for registration and academy communication.

First Name Last Name Email Address Phone Number Street Address City State ZIP Code Preferred Contact

2

Player Information

Information used for placement and coaching preparation.

Player First Name Player Last Name Date of Birth Current Grade School (optional) Experience Level Basketball Experience and Goals

3

Emergency Contact

Please provide someone other than the primary parent or guardian when possible.

Emergency Contact Name Relationship Emergency Phone Alternate Phone (optional)

4

Medical and Safety Information

Provide information that could affect safe participation.

Allergies (enter “None” if applicable) Medical Conditions or Limitations (enter “None” if applicable) Medications (enter “None” if applicable) Physician Name (optional) Physician Phone (optional) Health Insurance Provider (optional) Policy Number (optional)

5

Program Selection

Select the program that best matches your player’s experience and goals.

Preferred Training Days or Times (optional)

6

Policies and Permissions

All required acknowledgments must be completed before payment.

I have read and agree to the Terms of Service. I have read and agree to the Refund Policy. I have read and understand the Privacy Policy. I acknowledge and accept the Participant Waiver and Release of Liability. I authorize reasonable emergency medical assistance if I cannot be reached.

Photo and Video Permission I grant permission. I decline permission.

Parent or Guardian Full Legal Name Date

Typing your name and submitting this form constitutes your electronic signature.

7

Review and Payment

Review the selected program and complete payment when required.

Selected programNot selected

Amount due today$0.00