Clone of Adidas Jr. 3SSB Boys Basketball Registration

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Image Field
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Athlete 1* This field is required.
First Name
Last Name
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Jersey Size* This field is required.
Please Select
Please Select
YS
SM
YL
AS
AM
AL
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Top 3 Numbers for Jersey (No Guarantee! First Come First Serve)
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Best Contact Email* This field is required.
example@example.com
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Best Contact Phone (Call/Text)* This field is required.
Please enter a valid phone number.
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Grade* This field is required.
Please Select
Please Select
11th
10th
9th
8th
7th
6th
5th
4th
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Parents Name* This field is required.
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Best Contact Phone?* This field is required.
Please enter a valid phone number.
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🔹 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 H-Town 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 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.
I do not agree
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🔹 Medical Treatment Authorization* This field is required.
I authorize Lead Through Athletics 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 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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Parent/Guardian Signature
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Date Signed
Date
Month
Day
Year
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Any additional comments or needs we should know about?* This field is required.
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Are you or do you have any company interested in donating to Lead Through Athletics to help us get a bigger? (We are a 501c3 nonprofit organization.)* This field is required.
Yes
No
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Do you want to sponsor an athlete ( $25, $50 , 75, $100 $ 185) If So, a Rep will be in contact with you.* This field is required.
Yes
No
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My Products
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My Bag
1
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
Commitment Fee (Only if Paying Monthly)
Pay this only if you plan on making monthly payments
($200 + (185 x 3)
Invoice will be sent out 15th of each month beginning September 1, 2026
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Quantity
Falll Ball Dues (paid all at once below)
Jersey + Backpack + Dues From
Augest - November
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Full amount dues paid via Zelle
Send $800 via zelle to :
832.361.1932
Lead Through Athletics
Reciept available upon request.
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Total cost
20
Payment Methods
Debit Or Credit Card
Select PayPal Method
Choose from one of the PayPal options to make your payment.
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