Boys & Girls Club of Midland, Co-Ed Winter Basketball, PreK - 6th grade

Player's Information

• *

  I am the parent or legal guardian of this child and any additional children I register. I agree to the waivers posted at www.basinkids.org

  • Yes
• * First Name:
• * Last Name:
• * Address 1:
• * City:
• * ZIP Code:
• * Phone:
• * Email Address:
• * Confirm Email Address:

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Event fee	$80.00

Age, Grade, School, T-Shirt, Notes

• *

  Participant's Gender:

  • Male
  • Female
• * Date of Birth
• * Grade: --Choose-- 4 years old / PK K 1 2 3 4 5 6
• * School:
• * T-Shirt Size --Choose-- YS - Youth Small YM - Youth Medium YL - Youth Large AS - Adult Small AM - Adult Medium AL - Adult Large AXL - Adult Extra Large AXXL - Adult Extra Extra Large
• If interested in coaching please leave name & phone number:
• Notes or Preferences:

Adult Contact Information

• * #1 Adult Contact Name:
• * #1 Phone Number:
• #2 Adult Contact Name:
• #2 Phone Number:

Additional Player/s' Information

You may add a maximum of 11