Afterschool Registration Form

Parent's Email: *

Check here to receive email updates

Persons authorized to pick up student *

Student's Last Name *

Student's First Name *

Address *

Student's School *

Emergency Number *

Phone *

Student's Gender

Female

Male

Other

How did you hear about this SPDBasketball activity?

Electronic Signature *

Student's Grade *

Zip Code *

Date and time *

Student's Home Room Teacher *

I approve of this Parent/Guardian authorization. Signature required to process this registration *

Yes

No

Address 2

Select The School Program of Your Choice *

SOLD OUT: Oakland Terrace FALL 2023 - Thursdays 3:30-4:30pm - 7 clinics: 9/28, 10/05, 10/12, 10/19, 11/02, 11/9, 11/16

SOLD OUT: Oakland Terrace WINTER 2024 - Thursdays 3:30-4:30pm - 7 clinics: 1/11, 1/18, 1/25, 2/1, 2/8, 2/15, 2/22

Oakland Terrace SPRING 2024 - Thursdays 3:30-4:30pm - 7 clinics: Dates 3/14, 3/21, 4/4, 4/11, 4/18, 4/25, 5/2

I am the legal guardian / custodial parent *

Yes

No

Parent's Name *