Register now for HAPAL Basketball

Parent/Guardian Name(Required)

First Last

Parent/Guardian Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Cell Phone(Required)

Parent/Guardian Home Phone

Parent/Guardian Email

Emergency Contact Name

First Last

Emergency Contact Phone

I give permission for ________ to pick up my child from HAPAL Basketball practice in case I am not available.

Parent/Guardian Signature(Required)

Please type your full name as your electronic signature for this document.

Basketball Registration Fee

Total

Mentoring Through Sports – Basketball