Athlete Information

Date of Birth:*
Previous basketball experience:*
If Yes, please provide details:

Parent/Guardian Information

Name of parent/guardian:*
Relationship to athlete:*
Address same as athlete:*
Address, if different than athlete's:
E-mail confirmation:*
E-mail address (NOTE: all our communication will be done by e-mail):*
Emergency Contact Phone:*
Does the athlete have any medical condition or allergies that we should be aware of?*
If Yes, please specify:

Programs and Method of Payment

Please select a Program from the list (please check the Programs page before selection):*
If desired, please provide comments for the program choices made above:
Payment method (due during the first week of practice):*
How did you hear about us:*
If Other, please specify:
Security Code: