2020 UT Challenger Sports Basketball Clinic Player Registration
Player's First Name *
Your answer
Player's Last Name *
Your answer
Male or Female *
Age. Must be 6 years old and up *
Your answer
Player date of birth *
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DD
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YYYY
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parent/Guardian Mobile Number. (or best contact tel #) *
Your answer
E-mail Address. Please indicate if none available. *
Your answer
Please describe the player's diagnoses and/or special needs so we can do our best to accomodate. Please indicate list of medical conditions that we should be aware of. *
Your answer
Please indicate if the player needs assistive device such as wheelchair, braces, walker, etc.
Your answer
Basketball Clinics schedule is Sundays 2/2/2020 and 2/09/2020 from 11:30am - 1:00pm. Please arrive at 11:15am. Dates,time, and/or location is subject to change if needed. *
Please indicate which dates you are attending
I/We give permission for my son/daughter to participate in the Upper Township Challenger Sports Program. If my son/daughter is over the age of 18, I represent that I have legal authority to sign on their behalf. I/We agee to return equipment issued to my child in good condition as when received, except for normal wear and tear. I/We assume all risk of injury due to participation in this sport and release the Township of Upper and Upper Township Challenger Sports for any liability in this regard. I/We give permission to Upper Township Challenger Sports and Township of Upper to display my son's/daughter's photo *
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