Ironshore Youth Basketball Academy - Centre on Philanthropy
Ironshore Youth Basketball Academy Registration Form
Cost for Fall Term-$100
Child’s Name ________________________________________________________ Sex:
Male
Female YM
Age: __________________
Shirt Size:
YS
YL
S
M
L
XL
Address
________________________________________________________ ________________________________________________________
Mothers Name
Fathers Name
Home #
Home #
Work #
Work #
Cell #
Cell #
Email
Email
Doctor’s Name:____________________
Telephone Number:_________________
Does your child have any medical/health needs we should be aware of (including allergies/medication)? Yes No If yes, please list: ___________________________________________________ ___________________________________________________ I understand that photographs may be taken and used for Sandys 360 Centre promotional purposes. Consent is hereby given by the undersigned for the participation of __________________________________ in the (Student-Athlete Name) Youth Basketball Academy .
Signature: _____________________________
Date: _______________________
Cost for Fall Term-$100
Child’s Name ________________________________________________________ Sex:
Male
Female YM
Age: __________________
Shirt Size:
YS
YL
S
M
L
XL
Address
________________________________________________________ ________________________________________________________
Mothers Name
Fathers Name
Home #
Home #
Work #
Work #
Cell #
Cell #
Doctor’s Name:____________________
Telephone Number:_________________
Does your child have any medical/health needs we should be aware of (including allergies/medication)? Yes No If yes, please list: ___________________________________________________ ___________________________________________________ I understand that photographs may be taken and used for Sandys 360 Centre promotional purposes. Consent is hereby given by the undersigned for the participation of __________________________________ in the (Student-Athlete Name) Youth Basketball Academy .
Signature: _____________________________
Date: _______________________
