Youth Basketball | Poplar Springs Baptist Church

Parent/Guardian Information:

Parent/Guardian *

First

Last

Parent/Guardian Contact Number *

Parent/Guardian Email *

Emergency Contact (Non-Parent)

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Total Number Of Kids:

How Many Kids Are You Registering?

Number of Kids: 1

Select the number of kids you want to register for basketball.

Child #1 Information:

Please, fill out all required information for Child #1.

Child #1 Name *

First

Last

Child #1 Birthdate *

Child #1 Grade *

Child #1 T-Shirt Size *

Child #1 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #1 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #1 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #2 Information:

Please, fill out all required information for Child #2.

Child #2 Name *

First

Last

Child #2 Birthdate *

Child #2 Grade *

Child #2 T-Shirt Size *

Child #2 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #2 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #2 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #3 Information:

Please, fill out all required information for Child #3.

Child #3 Name *

First

Last

Child #3 Birthdate *

Child #3 Grade *

Child #3 T-Shirt Size *

Child #3 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #3 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #3 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #4 Information:

Please, fill out all required information for Child #4.

Child #4 Name *

First

Last

Child #4 Birthdate *

Child #4 Grade *

Child #4 T-Shirt Size *

Child #4 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #4 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #4 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #5 Information:

Please, fill out all required information for Child #5.

Child #5 Name *

First

Last

Child #5 Birthdate *

Child #5 Grade *

Child #5 T-Shirt Size *

Child #5 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #5 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #5 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #6 Information:

Please, fill out all required information for Child #6.

Child #6 Name *

First

Last

Child #6 Birthdate *

Child #6 Grade *

Child #6 T-Shirt Size *

Child #6 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #6 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #6 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #7 Information:

Please, fill out all required information for Child #7.

Child #7 Name *

First

Last

Child #7 Birthdate *

Child #7 Grade *

Child #7 T-Shirt Size *

Child #7 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #7 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #7 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #8 Information:

Please, fill out all required information for Child #8.

Child #8 Name *

First

Last

Child #8 Birthdate *

Child #8 Grade *

Child #8 T-Shirt Size *

Child #8 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #8 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #8 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #9 Information:

Please, fill out all required information for Child #9.

Child #9 Name *

First

Last

Child #9 Birthdate *

Child #9 Grade *

Child #9 T-Shirt Size *

Child #9 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #9 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #9 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Child #10 Information:

Please, fill out all required information for Child #10.

Child #10 Name *

First

Last

Child #10 Birthdate *

Child #10 Grade *

Child #10 T-Shirt Size *

Child #10 Jersey Number (Choice #1)

Enter this number in order of your preference (this is your first choice). Please note, we try to accommodate all requests, but as many people already have jerseys, many numbers are already taken, but we do our best to get everyone as close as we can.

Child #10 Jersey Number (Choice #2)

Enter this number in order of your preference (this is your second choice).

Child #10 Jersey Number (Choice #3)

Enter this number in order of your preference (this is your third choice).

Allergies/Medical Conditions

Waiver of Liability *

Yes, I agree for all children registered.

I release Poplar Springs Baptist Church, the sports program, church staff, Greer Christian Basketball League & coaches thereof from any claims that might result from my participation. I understand that by wearing the Poplar Springs Baptist jersey I am I am consenting to presenting myself on the basketball court in a Christlike manner and by registering, I promise to do present myself as such.

Registration

PSBC Basketball 2024 Registration

Parent/Guardian Information:

Emergency Contact (Non-Parent)

Total Number Of Kids:

Child #1 Information:

Child #2 Information:

Child #3 Information:

Child #4 Information:

Child #5 Information:

Child #6 Information:

Child #7 Information:

Child #8 Information:

Child #9 Information:

Child #10 Information:

Allergies/Medical Conditions

Contact