Register 2020 Summer Softball Day Clinic Registration Player's Name* First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent's Email* Cell Phone*Age*Birth Date* Date Format: MM slash DD slash YYYY Gender*Please SelectMaleFemaleGrade*School*HeightFeet*Inches*Weight*Position*Summer Softball Clinic*6u & 8u Summer Softball Session 1 $4510u & 12u Summer Softball Session 2 $4514 and up Summer Softball Session 3 $45Camp Total $0.00 Parents Consent* My child is in excellent physical health and capable of participating in strenuous physical activity, and waive Nineteen 9 Sports Inc and Riverfront Sports and/or their assigned staff, coaches or assigned responsible person/s of any and all responsibilities for injury or illness. I hereby authorize the director of Riverfront Sports or Their assigned responsible person to act for me according to their best judgment in any emergency requiring medical attention. I understand that I am solely responsible for the payment of any such medical expenses and must provide Riverfront Sports with proof of insurance. I also understand that my payments are non-refundable, non-transferable under any circumstances. Payment Method*Credit card payments will be processed securely via QuickBook Payments. We do not store or save any credit card data on the Backcourt Hoops website.Credit CardCheckBilling Address* Same as Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name CAPTCHANameThis field is for validation purposes and should be left unchanged. Previous tab Next tab
