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Girls Basketball Fall Youth Clinics
Girls Basketball Freshmen Clinics
Payment
Review
Participant Information
Required
Participant's Full Name
*
Required
Date of Birth
*
Required
Current School
*
Required
Insurance Carrier
*
Required
Insurance Policy Number
*
Parent Information
Required
First Name
*
Required
Last Name
*
Required
Please enter a valid email address with the format youraddress@yourdomain.
Email
*
Required
Please enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.
Phone Number
*
Required
Home Address
*
Required
City
*
Required
State
*
Required
Please enter a 5-digit ZIP code or a 9-digit ZIP code with a hyphen after the first 5 digits.
Zip Code
*
Emergency Contact Information
Required
Emergency Contact Name
*
Required
Phone Number
*
Required
Relationship to Camp Attendee
*
Camp Information
Required
Session 1: April 29, 6-8PM, $35
*
Required
Session 2: May 2, 6-8PM, $35
*
Required
Session 3: May 6, 6-8PM, $35
*
Required
Session 4: May 9, 6-8PM, $35
*
Required
Session 5: May 13, 6-8PM, $35
*
Signatures
Required
Primary Guardian's Electronic Signature
*
Required
Participant's Electronic Signature
*