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"HUSKIES BASKETBALL SKILLS ACADEMY" REGISTRATION

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* Indicates required field

Participant Full Name *

First

Last

D.O.B (mm/dd/yyyy) *

Phone Number *

Grade *

Name of school currently attending *

Position *

Height *

Jersey size *

Participant Email *

Parent Name: *

Parent Email *

Street Address *

Apt#/Suite# *

City *

Province *

Postal Code *

EMERGENCY INFORMATION

Emergency Contact Name *

First

Last

Phone Number *

State relationship *

Participant Health Card Number *

Please specify any medical conditions: *

If your daughter has any allergies, she must be equipped with an epi-pen at all times.

If your daughter is asthmatic, she must be equipped with a puffer at all times.

Failure to meet these safety conditions will result in the removal of your daughter's participation for that day. NO REFUNDS.

PAYMENT INFORMATION:
Please indicate how you will be paying.

Payment Options *

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