Lopatcong Athletic Association 2018 - 2019 Basketball Registration Form
2018 - 2019 Lopatcong Basketball Season
Registration Closes October 19, 2018

Registration Fee:
$90 instructional skills (kindergarten, 1st, 2nd)
$100 competitive (includes 3rd grade non-competitive)

**The following forms are REQUIRED and available on the LAA Website/Basketball **
Please fill out and return to your Basketball Coach.
1. SPORT-PARENT CODE OF CONDUCT
2. MEDICAL TREATMENT AUTHORIZATION AND LIABILITY RELEASE

**PAYMENT MUST BE MADE UPON REGISTRATION**
Online Registration is PayPal/Credit/Debit ONLY
*DO NOT SEND CHECKS OR CASH*
If you do not pay when you register, then the registration process is incomplete and will not be processed as a registered participant.

Email address *
Name of Participant *
Your answer
Date of Birth (MM/DD/YYYY) *
Your answer
Age of Participant: *
Your answer
Current Grade: *
Home Address *
Your answer
City *
Your answer
Relationship to Participant *
Parent # 1 Name *
Your answer
Parent # 1 Email *
Your answer
Parent # 1 Phone Number *
Your answer
Relationship to Participant *
Parent # 2 Name *
Your answer
Parent # 2 Email *
Your answer
Parent # 2 Phone Number *
Your answer
T-shirt Size *
Interested in Coaching? *
Name & Contact Number
Your answer
Registration Fee *
Payment Type
We accept PayPal as a form of payment for online registration. The link to pay is on the website lopatathletics.com/Basketball. Please make sure to include your PayPal email address for verification. WE ARE NOT ACCEPTING CHECKS/CASH FOR ONLINE REGISTRATION.
PayPal Email Address
Your answer
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