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2019-2020 Scottsville Youth Basketball Registration Form

PLAYER INFORMATION

* First Name:

* Middle Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Email:

* Birthdate:

* Gender:

* Grade:

* School Attending:

* Age as of January 1, 2020:

* Player's Shirt Size: Youth (S,M, L, XL):

* Player's Shirt Size: Adult (S,M,L,XXL):

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* Home Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

* Lastname:

* Email:

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

* indicates required fields