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GALLERY
BALLIN F.A.S.T.
Registration
Participant Information
First name
*
Last name
*
Birthday
*
Month
Month
Day
Year
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
Service(s) of Interest
Group Training
Personal Training
Gym Rental
AAU Information
Basketball Academy
Other
Submit
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