RegistrationPlease complete and submit the required and requested information below: PLAYER 1: PERSONAL INFORMATION Program: * (select) Summer Mini Camp (July 10th) Summer Mini Camp (July 17th) Summer Mini Camp (July Sessions) Summer Mini Camp (August 14th) Summer Mini Camp (August 21st) Summer Mini Camp (August Sessions) Summer Mini Camp (All Sessions) Division: * (select) Minis (ages 5-8) Juniors (ages 8-11) Seniors (ages 12-14) Have you previously participated in a Bed Stuy Sports event? (select) New Recruit Seasoned Veteran Name * First Name Last Name Nickname Birthday * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone (if applicable) * (###) ### #### Email (if applicable) School Grade (select) 1 2 3 4 5 6 7 8 9 10 Jersey Size (select) S M L XL PLAYER 1: MEDICAL HISTORY Is there a history of: Asthma Allergies Heart Condition Head Injuries Prescription Medication None Other If "Other", please explain: PLAYER 1: PARENT/GUARDIAN INFORMATION PARENT/GUARDIAN 1 Name * First Name Last Name Cell Phone * (###) ### #### Email * Would you or a family member be interested in coaching and/or volunteering? * (select) Yes No PARENT/GUARDIAN 2 (OPTIONAL) Would you like to include a second parent/guardian? Yes No If "No", please leave the following fields blank and continue to Emergency Contact information. Name First Name Last Name Cell Phone (###) ### #### Email Would you or a family member be interested in coaching and/or volunteering? (select) Yes No EMERGENCY CONTACT INFORMATION Name * First Name Last Name Relationship to Player Cell Phone * (###) ### #### Email * PLAYER 2: PERSONAL INFORMATION (IF APPLICABLE) Will a second player be joining you? Yes No If "No", please leave the following fields blank and continue to Referral Information. Name First Name Last Name Cell Phone (###) ### #### Email REFERRAL INFORMATION How did you hear about Bed Stuy Sports? (select) Facebook Instagram Google Ad Relative/Friend/Colleague Other If "Other", please explain: Thank you!
