Rising Stars After School Registration

Rising Stars (Grades 6-8) Boys or Girls Basketball Clinic Registration

Participant's Name(*)

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Clinic Choice(*)

Boys Girls

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Parent/Guardian

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Player's DOB(*)

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Grade(*)

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Interested in AAU Basketball?(*)

Yes No

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Interested in lessons?(*)

Yes No

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Address(*)

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City/Town(*)

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Zip Code(*)

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Phone(*)

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Contact Method(*)

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Email(*)

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Confirm Email(*)

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Emergency Contact

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Emergency Phone

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Please Note: At least 5 participants are required to run a clinic. If you cancel your spot with less than 48 hours notice you will be charged a $50 processing fee. No refunds will be given for any sessions missed for any reason.

The undersigned accepts fully that the Kingsbury Club, its shareholders, directors, officers, employees, representatives, and agents cannot be held responsible for any loss, claim, injury, damage, or liability sustained or incurred during participation on the premises of the Kingsbury Club. The Kingsbury Club reserves the right to photograph program participants for publicity purposes, in print or electronic media.

I have read and understood the above Disclaimers(*)

Yes

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Rising Stars (Grades 6-8) Boys or Girls Basketball Clinic Registration

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