August 2nd JA Basketball Clinic Registration

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Saturday August 2nd, girls and boys 3rd through 8th grade basketball clinic. All players will receive a JA basketball t-shirt. JA coaching staff and players will conduct the clinic. The clinic will feature an outside carwash - hot dog sale - basketball gear sale.

Email *

Record my email address with my response

Event Information:

First Name *

Last Name *

Grade (2025/2026) *

Player Date of Birth M/D/Year *

Player Gender *

Female

Male

Parent / Guardian Name (First and Last) *

Parent / Guardian Cell Phone Number *

Parent / Guardian Email Address *

Emergency Contact Name *

Emergency Contact Cell Phone # *

Medical Information (Allergies / Conditions) *

T-Shirt Size (Adult Sizes) *

Basketball Liability Waiver - I am aware that participation in the Jefferson Academy Basketball Clinic there are some inherent risks an injury can occur. I the parent / guardian, assume the risk of all injury and agree not to hold the Jefferson Academy Basketball Camp, the camp directors, coaches, the school, or any volunteers liable for any and all injuries from participating in the JA Basketball Clinic. By signing this waiver, I also authorize the use of pictures of the above named participant to be posted on the Jefferson Academy web site or advertising media published by Jefferson Academy. Please print /sign your name. *

Payment *

Payment Made Cheddar Up

Payment Check Day of Clinic - Made to JA Boosters / JA Basketball

Cash Payment Day of Clinci

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