K-5 Intramural Basketball Registration

Child's First name

Child's Last name

Child's Date of Birth

Día

Mes

Año

Parent/ Guardian Email

Parent Guardian Phone

What School Does Your Child Attend?

How Did You hear about us?

Please share any medical conditions or concerns.

Emergency Contact Information

#1 Emergency Contact Full Name

#1 Emergency Contact Phone

#2 Emergency Contact Full Name

#2 Emergency Contact Phone

Registration Fee

65 US$

Registration includes a T-shirt.