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Basketball Clinic Registration Form
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* Indicates required question
Student's First Name
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Student's Last Name
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Your answer
Current School
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Current Grade
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Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Street Address
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City
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State
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Zip Code
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Student Contact Phone #
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Student Contact E-mail
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How did you learn about the course offering?
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E-mail
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Please add any questions or comments you might have
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Parent or Guardian First Name
*
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Parent or Guardian Last Name
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Relationship to Student
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Parent or Guardian Phone Number
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Parent or Guardian E-mail Address
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