Afterschool Registration Form

Student's Home Room Teacher *

Persons authorized to pick up student *

How did you hear about this SPDBasketball activity?

Date and time *

Electronic Signature *

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

Yes

No

Student's School *

Select The School Program of Your Choice *

Oakland Terrace FALL 2021 - Thursdays 3:30-4:30pm - 8 clinics: 10/07, 10/14, 10/21, 10/28, 11/11, 11/18, 12/02, 12/09

Oakland Terrace WINTER 2022 - Thursdays 3:30-4:30pm - 8 clinics: 1/20, 1/27, 2/03, 2/10, 2/17, 2/24, 3/03, 3/10

Oakland Terrace SPRING 2022 - Thursdays 3:30-4:30pm - 8 clinics: 3/31, 4/07, 4/21, 4/28, 5/05, 5/12, 5/19, 5/26

Zip Code *

Address 2

Address *

Emergency Number *

I am the legal guardian / custodial parent *

Yes

No

Parent's Name *

Student's Grade *

Student's Gender

Female

Male

Other

Student's Last Name *

Student's First Name *

Parent's Email: *

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Phone *