Elite Academy: K5-3rd Grade Quarterly Registration

* Required Fields
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Fee: $230.00
*Player First Name
*Player Last Name
*Current Grade
*Current School
*Parent/Guardian #1 (Name)
*Email Address
*Cell #
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Parent/Guardian #2 (Name)
Email Address
Cell #
Home Phone #
Medical conditions? If so, please let us know.
Medical Release
As a parent or guardian of the above-named player(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 program. I furthermore hereby release, discharge, and or otherwise indemnify the league, administrators, & coaches against any claim by or on 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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