Court Kings Basketball Academy

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* Parent/Guardian First Name:

* Parent/Guardian Last Name:

* Home Address:

Email:

Home Phone:

Work Phone:

Cell Phone:

* Team Name:

* Player First Name:

* Player Last Name:

* Player #1:

* Player #2:

* Player #3:

* Player #4:

* Player AAU Membership Number #:

* Select Grade Division of Participation::

1st-2nd Biddies

3rd-4th Pee Wee

5th-6th Juniors

7th-8th Seniors

* Gender:

* Date Of Birth:

* Medical/Emergency Name of Contact Information:

* 2nd Medical/Emergency Name of Contact:

* Contact Phone #1:

* Contact Phone #2:

* Relationship to Player:

* Name of Insurance Carrier:

* Insurance Carrier Policy Number #:

* indicates required fields

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