Upward Basketball and Cheerleading REGISTRATION!

Last Name:*

First Name:*

Date of Birth (month/day/year):*

Gender:*
Boy
Girl

Grade (2011-2012 school year):*
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Kindergarten

Address:*

Zip Code :*

City:*

State :*

Home Phone #:*

Cell Phone #:*

Mother/ Guardian Email:*

Father/ Guardian Email:*

Which sport is the child participating in?:*
Basketball
Cheerleading
Not sure yet

How many years has your child played organized basketball or cheerleading?:*

Player Notes (if any):

Would you be willing to coach your child's team?:*
yes
no

The name of the parent that will be willing to coach their child's team.:

Church (if you attend regularly, which one?):

Have you ever been to Batley?:
yes
no

Would you like more information on Batley's youth programs?:
yes
no

Sign up for text message updates?:*
yes
no

Input cell phone provider:

Input 10 digit cell phone number:

Please type the text below: