Backcourt Hoops  Online Registration Form:

[Note: After submitting form, you will be taken to a screen from which you can pay online via safe, secure PayPal with your credit card or online check. You will also be given information on how to pay by check instead.]

            
     

League Fee:           $    Boys 6th

Team Name:                    

Team Street Address:    

City:                                   

US State:                               Zip:    

 

Coach's Name:                 

Coach's Email:                  (required)

Coach's Telephone:          (required) with area code

Coach's Cell  Phone:        (required) with area code

Second Contact Name:                 

Second Contact Email:                  (required)

Second ContactTelephone:          (required) with area code

Second Contact Cell  Phone:        (required) with area code


 

Comments/ Special Requests: we will attempt to honor your requests

     

     
My players are in excellent physical health and capable of participating in strenuous physical activity, and waive Backcourt Hoops of any and all responsibilities for injury or illness. I hereby authorize the director of Backcourt Hoops to act for me according to their best judgment in any emergency requiring medical attention. I understand that each players parents are solely responsible for the payment of any such medical expenses. I also understand that my payments are non-refundable, non-transferable under any circumstances. By Pressing the submit button you agree to the above.

  Please wait it may take up to 30 seconds to process after you click submit  and go to confirmation page