Registration | High Level Basketball

Clinic Registration Options

Name(Required)

First Middle Last

Date of Birth(Required)

Gender(Required)

Male

Female

Unspecified

School(Required)

Grade in Fall 2023(Required)

Students entering second grade can enroll as third grade if the drop down is not working!

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name(Required)

First Last

Cell Phone(Required)

Home Phone

Email(Required)

Name

First Last

Cell Phone

Home Phone

Medical Insurance Company(Required)

Medical Insurance Group Number

Medical Insurance Policy Number(Required)

Medical Insurance Policy Holder(Required)

Medical Insurance Phone Number

Clinic Registration Options(Required)

Total