4th – 6th Grade Basketball Orange-and-Brown-Black-Illustrative-Creative-Basketball-Tournament-Flyer-3 2027 4th-6th Grade Basketball Player Name First Last SchoolGradeAgeParents' Names(Required)Full Address(Required) Street Address City Township 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 Phone(Required)Email(Required) Division Boys Girls Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult Extra Large Registration fee: Resident $60 Registration fee: Non-Resident $70 Checks payable to: Thomas Township General Fund Registration Deadline – November 25th ($25 late fee after this date till December 4th Registration Closes November 25thWE CANNOT GUARANTEE REQUESTS. Volunteer Coaches determine their teams practice times. We can only honor requests between siblings/family members.My signature on this form verifies that I understand Thomas Township, its employees and volunteers, shall not be responsible for any injury to my child while participating in this soccer program. I waive and release Thomas Town-ship from any and all claims.Concussion Information Acknowledgement(Required) I agree that I have read the concussion information provided above.Parent / Guardian Signature(Required)Your NameYour NameYour NameYour NameDate(Required) Volunteer Coach Name:Coach's PhoneShirt Size
