Upward Basketball & Cheerleading Registration Form 2014

Note: If you have any problems using this form, contact Jennie Whetstone at jwhetstone@mybethel.org
PARTICIPANT CONTACT INFO:
Name: Last First MI
Address
City State Zip
Home Phone
Parent's Email
Player Information, if any (allergies, special needs, etc.):
 
If applicable, please list ONE friend your child would like to have on the same team
 
How many years has your child played organized basketball?
 
Gender
Grade (2013-14 school year)
Date of Birth ? (MM/DD/YYYY)
Would you be willing to coach your child's team?
 
If yes, please provide your name
 
If applicable, select ONE night your child CANNOT practice.
Can't practice
Please select a date and time for your child to attend an evaluation session:
 
PARENT/GUARDIAN INFO:
Father/Guardian
Cell Phone
Mother/Guardian
Cell Phone
Where does your family regularly attend church?
 
How did you hear about Bethel's Upward League?
 
EMERGENCY CONTACT:
Name
Relationship
Daytime Phone
Evening Phone
Payment:
Participant Fee
PERMISSION TO PHOTOGRAPH
I understand that my child may be the subject of photographs or videos taken by Upward staff for program and publicity purposes, but I must authorize the use of these photographs by the church. NO names or other personal information will be used with any of the pictures or video.
   - denotes required fields