2022- 2023 Basketball Player Registration Form

* Required Fields
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Fee: $60.00
 
This is the participant registration form for St. Philip's basketball. 
Girls & Boys Ages 3-14

 

 

Children must be registered to participate.

Total Registration Fee is $60 (Includes Skills & Season)

 

Registration ends December 1st, 2022

 

Basketball Skills

Ages 3-14 only

Offered at no additional cost

 

Skills Dates 

November

1st-------3rd -------8th-----13th

 

Skill Practice Times  

6:00 pm - 7:30 pm

(Please note times and dates are subject to change)

 

Season Practice Begin

December 6th, 8th, and 13th  All Ages 

(Before Christmas Break)

 

 

Saturday League Play

Start: January 14th  

 

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
Don't type in this field
*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?
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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