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GALLERY

BALLIN F.A.S.T.

3-on-3 Basketball Academy

Registration Form

Participant Information

First name*

Last name*

Birthday*

Gender*

Female

Male

School Name*

Grade*

Parent/Guardian Information

Parent's First Name*

Parent's Last Name*

Relationship to Participant*

Phone (Primary)*

Phone (Secondary)*

Email*

Address*

City*

State*

Zip*

Emergency Contact Information

Emergency Contact First Name*

Emergency Contact Last Name*

Relationship to Participant*

Emergency Contact Number*

Medical Information

Allergies

Existing Medical Conditions

Medications Currently Taking

Primary Care Physician

Primary Care Physician Number

Participation Details

T-shirt Size*

Youth S

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

Adult XL

Special Requirements

Consent & Agreements

Please check all boxes that apply*

Parental/Guardian Consent for Participation

Medical Release and Liability Waiver

Consent for Emergency Medical Treatment

Photo/Video Release

Acknowledgment of Academy Rules

Additional Information

How did you hear about us?

Flyer

Friend

Online

Other

Comments or Questions

Important Notes:

Registration Fee: The fee for participation in the 3-on-3 Basketball Academy is $200. This fee includes access to all training sessions, a t-shirt, and other academy resources.

Payment Instructions: Please ensure that the registration fee of $200 is paid in full by August 30, 2024. Payments can be made in cash, or credit card.

FOLLOW US!

beallinfast@gmail.com

205-266-5900

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