Lockwood 3-5 Basketball Registration
This form must be completed by parent or guardian of participant. Fee of $30 is required to process registration + online fee of $2.
Email address *
Student Name *
Your answer
Grade *
Jersey Size
Address *
Your answer
Phone *
Your answer
Parent Names *
Your answer
Are you interested in being a volunteer coach? Meeting will be held at 6pm on March 1st in Intermediate Library. *
Emergency Contact Name and Phone number *
Your answer
Doctor Name and phone number *
Your answer
Hospital Preference *
1. Are there any medical or health factors or limitations that might affect participant’s performance in the activity? *
Is participant taking any medications or have a condition that may affect participant’s safety or performance in the activity? *
Is participant required any special accommodations (due to disability) to participate in the activity?
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