Basketball Registration Form

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* 1. Player name:

First name

Last name

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* 2. Date of birth:

Date / Time

Date

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* 3. Gender:

Male

Female

Non-binary

Prefer to self-describe, please specify

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* 4. Current grade:

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* 5. Years of basketball experience:

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* 6. Position(s) played:

Point guard

Shooting guard

Small forward

Power forward

Center

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* 7. Please list any injuries, health issues, or activity limitations:

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* 8. Parent/Guardian 1 name:

First name

Last name

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* 9. Parent/Guardian 2 name:

First name

Last name

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* 10. Primary contact email:

Email address

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* 11. Primary contact phone number:

Country Code

Phone number

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* 12. Address:

Street address

Street address line 2

City

State

Zip code

Country