Clinic Registration Parent InformationName(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Child InformationChild Name(Required) First Last Child Gender(Required) Male Female Child Basketball Experience(Required)Metro AMetro BCYOTown RecreationNoneChild Grade(Required)2nd Grade3rd Grade4th GradeChild Shirt Size(Required)Youth SYouth MYouth LAdditional notes for our teamClinic ticket(Required) $50 Clinic – 91 ticket(s) remaining. Total Credit Card Δ
