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YOUTH BASKETBALL REGISTRATION PROCEDURE
November 14-March 13
Games begin December 5th
$100 per child
Please complete this form with credit card information and return it to the Community Education office between August 24 and September 18 at 3:00 p.m. A lottery for Acton-Boxborough residents will be held on Monday, September 21st and participants will be notified VIA E-MAIL of league placement.
All registration forms received after 3:00 p.m. on September 18th will be processed on a space available basis.
YOUTH BASKETBALL REGISTRATION FORM
Name (1st child )____________________________________ Male/ Female Grade______ Age______
Name (2nd child )____________________________________ Male/ Female Grade_____ Age______
Name (3nd child )____________________________________ Male/ Female Grade_____ Age______
Address_________________________________________ Town_______________ Zip____________
Home phone _____________________ Work phone________________ Cell_____________________
** Email ________________________________________________ (PLEASE PRINT CLEARLY)
Parent/Guardian will coach _____Yes _______No (Please indicate which child(ren))
If yes, up to 2 childen are half price.
Name________________________________________ Email__________________________________
Full price/Half Price coaching
First child $100 $________/ $___________
Second child $100 $________/ $___________
Additional children $100 x number of children $________
TOTAL $________
Payment Check #____________
Credit Card #__________ ____________ __________ ______ Exp________ CID__________
(last 3 numbers on signature strip)
Name on Card_______________________________________
Signature ___________________________________________
Office Use only: Tr #__________ Date Received _________________ Time _____________