Full Name *
Date of Birth * (MM/DD/YYYY)
Age Group * 5–8 Years (8:00 AM)9–12 Years (10:00 AM)13–15 Years (11:00 AM)16–18 Years (12:00 Noon)
Current Grade * 1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade
School Name *
Home Address *
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Phone *
Emergency Contact Name *
Emergency Phone Number *
Previous Teams / Experience
Preferred Position GuardForwardCenterAny Position
Jersey Size Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XL
Medical Conditions / Allergies
Health Insurance Provider
Consent for Participation I agree and give my permission for participation.
Photo/Video Release Agreement I agree and give permission for photo/video usage.
Parent Signature (Typed Full Name) *
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