Your Name Your E-mail address
Kindergarden & Grade One Basketball Program Winter Basketball AAU Basketball
Skill Level: Beginner Average Above Average Exceptional
# of years playing organized basketball
Child's Name School Grade Address Zip Home Phone Birthdate Boy Girl Age
Mother's Full Name Mother's Address Zip Place of Work Job Title Daytime Phone Evening Phone Other Number
Father's Full Name Father's Address Zip Place of Work Job Title Daytime Phone Evening Phone Other Number
Guardian's Full Name Guardian's Address Zip Place of Work Job Title Daytime Phone Evening Phone Other Number
Emergency Contact Phone
I accept all the rules of the Friars Club, Inc. and release them from any liablity and responsiblity from my child. I give permission to Friars Club to use my child's likeness for public relations purposes, to have my child attend field trips, and to get proper medical treatment in an emergency situation.
Parent/Guardian Date
Signed copy must also be on file at Friars Club, Inc.
Your involvement is important to your child's success! We are looking for 100% volunteer participation in the Parent Club! Please volunteer for even just one item:
Officer in Parent Club Sell concessions during games Donate concession Your ideas
Preparing for the future
Would you be interested in finding out the requirements for the Chip Hein Memorial Scholarship? Yes No
Demographic Information
This information is for demographic reporting for our various funding sources. This information does not effect my child's acceptance or position in any of our programs. Ethnic background: White Hispanic Black Asian Other
Yearly Income Below 10,000 10,000 - 14,999 15,000 - 19,999 20,000 - 29,999 30,000 - 49,999 50,000 and above
Community:
Household: 1 Parent Other Guardian 2 Parent # of other children in the household