Lockesburg Pee Wee Basketball Registration Form
Legacy Academy will host the Lockesburg PeeWee basketball program. This will be for students in the 3rd-6th grades. Age groups may be combined to make teams. Students may play up but not down.
Any student in the Lockesburg community or the surrounding area is welcome to sign up and join. A child does not have to be a student at Legacy Academy to play on the PeeWee team.
Our teams will play teams from Foreman, Horatio, De Queen, Nashville, Dierks, Mineral Springs, and maybe Acorn & Delight.
Games will be in December & January. A schedule will be made available as soon as possible.
There will be home and away games.
There will most likely be 4-7 games total.
Teams will begin practicing in November.
Certain COVID-19 mandates and rules may apply.
Volunteers will be needed to help coach teams.
Volunteers will be needed to operate the gate, concession stand, and scoreboard for home games.
Cost: $30 per child--included in this cost is a uniform jersey and a pair of shorts issues to your player.
DEADLINE: FORMS MUST BE SUBMITTED by October 21st. Paper forms may be printed and submitted at the Legacy Academy Office in Lockesburg or forms may be submitted online.
Student's Current Grade:
2nd grader who would like to play up
Preferred number if available. (no digit higher than 5--example: 55 is fine, 44 is fine, 03 is fine. 56 is not.) Preferred numbers are not guaranteed and players must accept the number assigned to them.
Parents' Contact Phone Numbers:
Parent, are you willing to coach or help coach?
Yes, I can help volunteer (check all that apply):
work in concession stand
PAYMENT: Send cash or check to the office or log on to the Warrior store on the website and pay your fee! Registration is $30 and covers the cost of a jersey & shorts for your player.
Will pay online at
(Go to store)
Will pay at office
I hereby give my consent for the above-named student to participate in the Pee Wee basketball hosted by Legacy Academy in Lockesburg. I realize that there is a degree of danger involved in almost any activity associated with sports, recreation, or physical activities and will not hold Legacy Academy or the PeeWee program responsible for injury or harm to my child. If emergency medical action or treatment is required and neither parent nor guardian can be contacted, I hereby give my consent for the student named above to be administered medical care by the physician or licensed hospital deemed most expedient by the coach or program representative in charge for the good of my child. The local fire department or paramedic unit may be used or students may be transported to the nearest emergency facility. I understand that I am fully responsible for any expenses associated with or resulting from medical care administered to the above-named student (which might also include ambulance service) and agree to assume the financial responsibility for such services. I also understand that my child may be photographed, videotaped, or audiotaped by a program representative, parent volunteers, or public media personnel. I give my permission to release any photographs, video images, or audiotapes of my child taken during the PeeWee Program, for use in publications, website, social media, as well as public media use. In signing this application, we as parents/guardians realize we are entering into a contract with Legacy Academy (LA) and the PeeWee Program agreeing to familiarize ourselves with, abide by, and support the policies and rules established for the program. I acknowledge that my child may not be left unsupervised at the gym. We agree to follow the rules and be responsible for all incurred fees. This consent and authorization is to continue for the entire PeeWee program.
Yes, by checking this Box I understand the above and agree and acknowledge this checked box as my electronic signature.
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of LegacyMail.