Basketball Sign-Up
Player First Name *
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Player Last Name *
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What is the age of the basketball player? *
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Player's Date of Birth *
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Street address *
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Apartment Number
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City, State, Zip *
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What is a phone number of a parent or guardian? *
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2nd phone number if required or available.
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Email Address of Parent (if available)
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Allergies / Medications or special concerns:
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1. In the event of an emergency, and parent/guardian is unavailable, please notify: *
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Phone number of emergency contact named above? *
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Relationship to Player *
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2. Contact Two. In the event of an emergency, and parent/guardian is unavailable, please notify (must be an adult 18 years or older):
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Phone Number of 2. Emergency Contact
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Relationship to Player *
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