2018 Girls EXCELERATE Basketball Program

* Required Fields
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Fee: $175.00Registration fee for 1 child
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Participant Registration for the 2018 EXCELERATE Program
*Player First Name
*Player Last Name
*How (or from whom) did you hear about this?
*2018-2019 Grade
*Current School
*T-Shirt Size
Medical conditions? If so, please let us know.
*Any serious allergies? Please list all!
Second Child Registration
Registering a second child in your family?
 No 
 Yes - please apply second child discounted fee (+$125.00)
Sibling #2 First Name
Sibling #2 Last Name
2018-2019 Grade
Current School
T-Shirt Size
Medical conditions? If so, please let us know.
Any serious allergies? Please list all!
Parent/Guardian Information
*Parent/Guardian #1
*Email Address
*Cell #
Parent/Guardian #2 (Name)
Email Address
Cell #
Medical Release
As a parent or guardian of the above named participant(s), I hereby give my consent for emergency medical care as prescribed by a doctor or dentist to my dependent. I, the parent or guardian, agree that my child and I will abide by the rules of the Birmingham Basketball Academy's 2018 EXCELERATE Program. I furthermore hereby release, discharge, and or otherwise indemnify the league, administrators, & coaches against any claim by or in behalf of the registrant as a result of their injury in the program.
*Waiver Agreement
 
I have read and agree with the waiver. 
 
*Does your family have health insurance?
 Yes 
 No 
Total Due:
$ 
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