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Richmond Youth Basketball League
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1
Athlete 1
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First Name
Last Name
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2
Athlete 2
First Name
Last Name
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3
Best Contact Email
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example@example.com
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4
Best Contact Phone (Call/Text
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Please enter a valid phone number.
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5
Division
*
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Please Select
11th-12th
9th - 10th
7th - 8th
5th - 6th
3rd - 4th
1st & 2nd
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Please Select
11th-12th
9th - 10th
7th - 8th
5th - 6th
3rd - 4th
1st & 2nd
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6
Parents Name
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7
Best Contact Phone?
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Please enter a valid phone number.
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8
How did you hear about the League?
*
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Social Media
Friend/Family
Flyer
Website
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9
Playing experience
*
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Recreation
Competitive
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10
What skills are most important for your child to improve? (check all that apply)
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Shooting
Ball Handling
Defense
Basketball IQ
Confidence
Conditioning
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11
Would you like more info about our weekly training and after school program?
*
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Yes
No
Maybe
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12
🔹 Acknowledgment of Risk
*
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I, the undersigned parent/guardian, acknowledge that participation in basketball activities, practices, training sessions, games, and related events with Tx Supreme Fall Ball League (Lead Through Athletics) at 4 Quarters Gym involves risks, including but not limited to: falls, collisions, physical contact, sprains, broken bones, and other injuries. I understand these risks are inherent to the sport and cannot be eliminated.
I do not agree
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13
🔹 Waiver & Release
*
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In consideration of my child’s participation, I hereby release, waive, and discharge Tx Supreme Fall Ball League, Lead Through Athletics, 4 Quarters Gym, coaches, staff, volunteers, and affiliates from any and all liability, claims, or demands for personal injury, property damage, or wrongful death arising from participation in league activities, whether caused by negligence or otherwise.
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14
🔹 Medical Treatment Authorization
*
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I authorize Tx Supreme Fall Ball League and 4 Quarters Gym staff/volunteers to seek emergency medical treatment for my child in the event of injury or illness. I agree to be responsible for any associated costs.
I do not authorize
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15
🔹 Insurance Responsibility
I understand that Tx Supreme Fall Ball League and 4 Quarters Gym do not provide medical insurance for participants and that it is my responsibility to carry appropriate coverage for my child.
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16
Parent/Guardian Signature
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17
Date Signed
-
Date
Month
Day
Year
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18
Any additional comments or needs we should know about?
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19
Are you or do you have any company interested in donating to Lead Through Athletics? (We are a 501c3 nonprofit organization.)
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Yes
No
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20
Jersey Size
*
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Please Select
YS
SM
YL
AS
AM
AL
I already have mine
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Please Select
YS
SM
YL
AS
AM
AL
I already have mine
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21
My Products
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My Bag
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My Bag
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Great Product Name
$20
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Great Product Name
$20
Quantity:
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Size:
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Great Product Name
$20
Quantity:
1
Size:
Small
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Great Product Name
$20
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ORDER SUMMARY
Total cost
USD
Early Bird Registration ($250 After March 13)
$
200.00
+
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22
Payment Methods
Debit Or Credit Card
Select PayPal Method
Choose from one of the PayPal options to
make your payment.
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