Basketball Clinic Basketball-Training-Camp-Event-Flyer Player Name First Last Parents' 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 SchoolGradeAgeGenderPhone(Required)Email(Required) Resident Resident $60 Non-Resident $70 Division 4-5 years old 6-7-8 years old 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 20th ($25 late fee after this date till November 27th Registration Closes November 27thWE 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)
