Player Subscription: Blazers Basketball Club
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Email *
Participant Information:
Please provide the informal names of participants/parents, and please use BOTH upper and lower case as appropriate (ensuring CAPS LOCK is off). For example, if the participant goes by Chris, please type Chris and not Christopher or CHRIS.
Participant First Name: *
Participant Last Name: *
Gender:
 *
DOB (MM/DD/YYYY):
 *
MM
/
DD
/
YYYY
To identify the player's grade, please specify the High School graduation class he/she is in (i.e., the calendar year associated with the spring semester of their 12th grade school year):
*
What town is the participant from?
 *
If "Other" Town, please specify town name:
Parent 1
First Name:
 *
Parent 1
Last Name:
 *
Parent 1
Cell Phone:
 *
Parent 1 Email Address:
 *
Parent 2/Emergency Contact
First Name:
Parent 2/Emergency Contact
Last Name:
Parent 2/Emergency Contact
Cell Number:
Parent 2/Emergency Contact
Email Address:
General Comments (including any specific programs you are interested in)
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Alpha Youth Sports.