Clone of RICHMOND YOUTH BASKETBALL LEAGUE

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Athlete 1* This field is required.
First Name
Last Name
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Athlete 2
First Name
Last Name
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Best Contact Email* This field is required.
example@example.com
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Jersey Size* This field is required.
Please Select
Please Select
YS
SM
YL
AS
AM
AL
5
Best Contact Phone (Call/Text* This field is required.
Please enter a valid phone number.
6
Division* This field is required.
Please Select
Please Select
K-2ND
3RD - 4TH
7
ATHLETES GRADE ENTERING IN THE FALL* This field is required.
Please Select
Please Select
GRADE
KINDER
1ST
2ND
3RD
4TH
8
ATHLETE DATE OF BIRTH
Date
Year
Month
Day
9
Parents Name* This field is required.
10
Best Contact Phone?* This field is required.
Please enter a valid phone number.
11
How did you hear about the League?* This field is required.
Social Media
Friend/Family
Flyer
Website
12
Playing experience* This field is required.
Recreation
Competitive
13
WOULD YOU LIKE MORE INFORMATION ABOUT OUR AFTER SCHOOL PROGRAM IN THE FALL?* This field is required.
Yes
No
Maybe
14
🔹 Acknowledgment of Risk* This field is required.
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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🔹 Waiver & Release* This field is required.
In consideration of my child’s participation, I hereby release, waive, and discharge 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.
I do not agree
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🔹 Medical Treatment Authorization* This field is required.
I authorize 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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🔹 Insurance Responsibility
I understand that 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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Parent/Guardian Signature
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Date Signed
Date
Month
Day
Year
20
Any additional comments or needs we should know about?* This field is required.
21
My Products
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My Bag
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My Bag
Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costUSD
BABY BALLERS LEAGUE REGISTRATION

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Quantity
JERSEY FEE ONLY (ONLY IF YOU ATTENDED 2 BASKETBALL CAMPS
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Total cost
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Payment Methods
Debit Or Credit Card
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