2-3 IN-HOUSE CO-ED

Please fill out the form below for your 2nd or 3rd grader (Co-ED)
(payment will be on the following screen)

* Indicates required field

PLAYER'S NAME *

First

Last

PLAYER'S BIRTHDAY

MONTH *

DAY *

YEAR *

PLAYER'S GRADE *

2ND GRADE 3RD GRADE

ADDRESS *

Line 1

Line 2

City

State

Zip Code

Country

ARE YOU WILLING TO HELP? *

HEAD COACH ASSISTANT COACH NO THANKS

I hereby give my son/daughter permission to participate in the PTAA Youth Basketball program. I understand I am financially responsible for any medical bills incurred by my child while at practices or games. I authorize the staff of PTAA Youth Basketball to act as they deem fit in the event an emergency arises. I hereby release and forever discharge the PTAA Youth Basketball coaches from any and all manner of actions, suits damages, claims and demands on the account of personal injury or death arising from my child’s performance and participation in the above listed activities. *

I AGREE

PARENT/GUARDIAN CONTACT INFORMATION (PEOPLE YOU WOULD LIKE THE COACH TO CONTACT IN COMMUNICATIONS)

Name 1 *

First

Last

Phone Number 1 *

Email 1 *

Name 2 *

First

Last

Phone Number 2 *

Email 2 *

Name 3 *

First

Last

Phone Number 3 *

Email 3 *

Are there any days or times that are not ideal for your player? *

Other Comments *

Submit, I understand I have to pay on the next screen

2nd & 3rd GRADE
in-house

IN-HOUSE PROGRAM: 2nd & 3rd grade (CO-ED)

Please fill out the form below for your 2nd or 3rd grader (Co-ED)
(payment will be on the following screen)

2nd & 3rd GRADEin-house

IN-HOUSE PROGRAM: 2nd & 3rd grade (CO-ED)

Please fill out the form below for your 2nd or 3rd grader (Co-ED)​(payment will be on the following screen)

2nd & 3rd GRADE
in-house

Please fill out the form below for your 2nd or 3rd grader (Co-ED)
(payment will be on the following screen)