Upstart: Basic Basketball Fundamentals

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Registration for After-School Basketball Program

* School Name:

* Child's First Name:

* Child's Last Name:

* Child's Age:

Male

Female

School Name:

2nd Child's First Name:

2nd Child's Last Name:

Child's Age:

* Parent/Guardian #1 - First Name:

* Parent/Guardian #1 - Last Name:

* Parent/Guardian #1 - Email Address:

* Parent/Guardian #1 - Home Phone:

Parent/Guardian #1 - Work Phone:

Parent/Guardian #1 - Cell Phone:

Parent/Guardian #2 - Name:

Name In case of emergency - other than 1st parent/Guardian:

Emergency Phone #:

Parent/Guardian #2 - Cell Phone:

Pay Now with your major debit/credit/PayPal for a fast and easy experience!

Or by check, money order, make payable in the amount of $75.00 to Jesse Jackson and mail to: P.O. Box 261643; San Diego, CA 92196

Military Discount $65.00 per child
Two(2) siblings $130.00
Only one (1) discount applies.

If you have any questions, please call (858) 342-8277 or e-mail at jesse_jackson29@yahoo.com.

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Registration for After-School Basketball Program