Basketball B&G Registration Basketball Registration Boy & Girls 1st – 6th grade $95.00 plus $15.00 B&G Membership Membership Required! FacebookThis field is for validation purposes and should be left unchanged.B&G Basketball Oct 2025 Registration Price: PARTICIPANT REGISTRATIONName*Mailing Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Emergency Phone*Date of Birth* MM slash DD slash YYYY Membership Number*Gender* Male Female Shirt Size* YXS YS YM YL S M L School Presently Enrolled*Grade*1st2nd3rd4th5th6thIf enrolled in Middle School/Jr.-Hi, Last Elementary School AttendedHas child participated in Boys & Girls Club Program during the year* Yes No MEDICALDoes child have any Medical Problems?* Yes No If yes, Please ExplainChild’s PhysicianPhonePARENT INFORMATIONFather’s NameFather's EmployerFather's PhoneMother’s NameMother's EmployerMother's PhoneEmail* PERMISSION TO PLAYAs the parent or legal guardian of the child named above who is registered to participate in Boys & Girls Club activities for the current season, I hereby acknowledge to the Boys & Girls Club that I am not aware of any medical or other reason why my child should not be allowed to participate in Boys & Girls Club activities. In the event of accidental injury incurred while participating in Boys & Girls Club activities, I authorize Boys & Girls Club representatives to secure medical care for my child in the event I cannot be reached. Acting on my own behalf and on the behalf of my child as his/her parent or as his/her guardian, I hereby release Boys & Girls Club and its agents, staff, representatives, directors, coaches and anyone else acting on behalf of Boys & Girls Club activities, from any and all liability for any injury or condition resulting from his/her participation in Boys & Girls Club activities. I agree to reimburse the Boys & Girls Club at replacement cost for any uniform and/or protective equipment issued the child if said items are not returned within 30 days follow- ing the last date of the activities registered for herein and/or are damaged due to neglect. If Boys & Girls Club is required to seek collection and/or reimbursement of uniform and/or equipment by legal action, I further agree to pay all court costs and legal fees.Permission to Play Agreement* I agree Coupon Total $0.00 CAPTCHA TSAOClaserGAT2025-10-05T21:49:39-07:00
