LaunchTrack

Player Registration - $175.00

First name:

Last name:

Phone Number:

Email:

Address:

Address2:

City:

Province / State:

Postal / Zip Code:

How many children are you registering?:

Is the player male or female? If registering both male and female, select both and answer the next question accordingly:

Male

Female

Both (Multiple)

Player Name (Please list all if more than one and indicate male or female):

Player Age (Please list all if more than one):

Player DOB (Please list all if more than one):

Are there any medications being taken? (List each medication for all children if more than one):

Are there any known allergies? (If yes, please list):

Does the player(s) have asthma or any other type of breathing condition?:

If yes, is there an asthma pump available that can be brought to practices and games?:

Emergency Contact:

Emergency Contact Phone Number:

Jersey Size (Please list all if more than one):

Are you interested in coaching?:

The Grind & Hoop Factory Youth Winter Basketball League