Allendale Youth Basketball
*Please register separately for boys and girls.*
Parent Information
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Phone Number *
Email *
First Child's Information
First Name *
Last Name *
Age *
Grade *
Shirt Size *
Second Child's Information
First Name
Last Name
Age
Grade
Shirt Size
Clear selection
3rd Child's Information
First Name
Last Name
Age
Grade
Shirt Size
Clear selection
Person Other Than Parent To Be Notified In Emergency Situation When Parent Is Not Available
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Relationship *
Names of Person Other Than Parent To Whom Child May Be Released
I hereby give permission to Allendale Public School Licensed by the Department of Social Services to secure emergency medical and/or surgical treatment for the named minor child while in care. *
Non-emergency medical treatment or elective surgery is not included in this authorization.
Parent's First Name *
Parent's Last Name *
Today's Date *
MM
/
DD
/
YYYY
Name of child's physician or health clinic *
Phone Number *
City *
Zip Code *
Hospital Preferred for Emergency Treatment *
Health Insurance Policy Number *
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