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: