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Impact

Basketball & Cheerleading Registration 2017 Season


Skill evaluation dates: Friday, Nov 11 6:00-8:00PM or Saturday, Nov 12 10:00-12:00
Registration: Basketball _______ Cheerleading _______
Last Name_________________________________ First Name_______________________
Male / Female (circle one) Date of Birth ________/________/___________
Grade for 2016-2017 _____________
Address___________________________________________________________________________________
City ___________________________ State __________ Zip______________ Phone #____________________
Father/Guardian name __________________________ Phone #____________________
Email address ______________________________________________________________
Mother/Guardian name__________________________ Phone #____________________
Email address ______________________________________________________________
Emergency Contact name ___________________________ Phone #____________________
Are you willing to coach your son/daughters team? _______________
Do you have a home church, if so which one?_____________________
Are there any special notes? (allergies, asthma, etc.) ______________________________________________
Are there any days your child can not practice (Mon-Fri) ___________________________________________
Teammate request for carpooling (request is not a guarantee) ______________________________________
Uniform Sizing chart YXS YS YM YL AS AM AL AXL A2X (this will be filled out at the skill evaluation)
Uniform sizing basketball (jersey)_____ (shorts) ____ Cheerleading (skort) _____ (top) _____
__________________________________________________________________________________________
Skill Evaluation- To be filled out by evaluators only
Dribbling & Ball Handling ____ Layup ____ Movement ____ Shooting ____ Defense ____
Overall average _____
Payment $60.00 ____Paid ______________Method of payment ____ Total paid