2021- 2022 Basketball Player Registration Form

* Required Fields
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Fee: $55.00
 
This is the participant registration form for St. Philip's basketball. 
Girls & Boys Ages 3-12

 

 

Children must be registered to participate.

Total Registration Fee is $55 (Includes Skills & Season)

 

Registration ends December 17th, 2021

 

Basketball Skills

Ages 3-12 only

Offered at no additional cost

 

Skills Dates 

October

26th------28th

November 

2nd-------4th-------9th-------11th-------16th------- 18th

December

2nd-------7th------14th 

 

Skill Practice Times  

6:00 pm - 7:30 pm

(Please note times and dates are subject to change)

 

Season Practice Begin

January 2022, All Ages 

(After Christmas Break)

 Official time and dates will be determined  by Coaches

 

Saturday League Play

Start: January 15th  

 

Mandatory Parent Meeting

TBA

 

 

Participant Information
*First Name
*Last Name
*Gender
 Male 
 Female 
*Grade
*Date of Birth
mm/dd/yyyy
Birth Certificate Submitted
  
*Street Address
*City
*State
*Zip Code
*School
*Jersey Size
Participant Medical Information
Please check any medical conditions that apply
 Convulsions 
 Epilepsy 
 Diabetes 
 Asthma 
 Hyperactivity 
 Hayfever 
Please list other Medical Conditions/Allergies
List any and all medications
Evidence of Medical Physical Submitted
  
Parent / Guardian 1 Information
*Guardian 1 First Name
*Guardian 1 Last Name
*Relationship
*Guardian 1 Email
Home Phone
*Cell Phone
Work Phone
*Emergency Contact
*Emergency Contact Phone Number
*Volunteer hours you are able to provide?
Don't type in this field
Waiver
Waiver
I hereby grant permission to representatives of St. Philip's School & Community Center to provide care to my child in the event of injury or illness if I am not present.  Such care may include but shall not be limited to first aid treatment, transporting to a medical facility, or the summoning of emergency assistance.  I, the parent or appointed guardian of the above named child, hereby agree to indemnify and hold harmless St. Philip's School & Community Center and its officials, directors, managers, coaches and assistants from any liability for the above named child's activities of any nature with said organization.
*Waiver confirmation
 I have read and agree with the waiver. 
Refund Policy
The Policy
Registration fees are non refundable. 
*Refund confirmation
 I have read and understand the refund policy. 
Statistics
How did you hear about this program?
*Gender
*Ethnicity
*Race
Total Due:
$ 
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