Register and pay by check or Paypal

REGISTRATION with PAYPAL

Please note that all fields followed by an asterisk must be filled in.

I am registering for the following session:

	SPRING
	FALL
	WINTER
	SUMMER CAMP - #1 ADVANCED
	SUMMER CAMP - #2 BEGINNING/INTERMEDIATE
	SUMMER CAMP - #3 BEGINNING/INTERMEDIATE
	SUMMER CAMP - #4 BEGINNING/INTERMEDIATE

Player's First Name*

Player's Last Name*

E-Mail Address*

Street Address*

City*

State/Prov*

Zip/Postal Code*

Home Phone (e.g. 408-777-1234 )

Mobile Phone (e.g. 408-777-1234 )

Gender*

	Boy
	Girl

Current Grade Level*

School*

Height - feet

Height - inches

Parent/Guardian*

Health Insurer*

Health Policy Number*

Emergency Contact Name:*

Emergency Contact Phone #*

Agree to Use Internet Acces*

	Yes
	No

Approval to Post Child's Name (Roster and Verification)

	Approve
	Disapprove

I am ordering a new jersey (Jersey required for League play only, NOT Summer Camps)

	Yes
	No

Current Jersey Number

All players who register will agree to “Re-Evaluation,” our process of shifting players between teams to ensure that the talent in the league is fairly balanced. This team balancing will occur after the first two league games, which we hope to accomplish with the minimal amount of stress for all. Please click on the " Yes" button below to agree to team balancing or “Re-Evaluation.” (REQUIRED)

Yes

I would like to be considered to coach. If I volunteer to coach I agree to allow SCBA to conduct a confidential background check. The SCBA is dependent on competent and positive coaches volunteering their time and energy.

	YES
	NO

I understand that the SCBA is dependent on volunteer coaches, and that the SCBA reserves the right to use high school age coaches if a qualified adult coach is not available.

Understood and Agreed Upon

Last Name of Person Making Payment for this Application

Emails of other names to send information updates (like scores and schedule etc).

Please enter the word that you see below.