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Basketball Clinic Registration
Thank you for your interest in our Basketball Clinic with Bilqis Abdul Qaadir! This clinic is for youth ages 7 - 13 years old. As space is limited, we encourage you to fill out this form as soon as possible. We will follow up with you via email on or before October 20, with confirmation. Thanks and we look forward to seeing you at the event!
Parent/Guardian Information
Please complete all fields below.
Parent/Guardian Full Name *
Please enter your first and last name.
Your answer
Home Address *
Please enter your building or house number, street name and apartment number (if applicable).
Your answer
City, State and Zipcode *
Please enter your city, state and zipcode.
Your answer
Email Address *
Please enter a valid email address.
Your answer
Phone Number *
Please provide a phone number that you will use at the actual event.
Your answer
Additional Phone Number *
Please enter a secondary phone number.
Your answer
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