Registration Form HIGH FIVE AMERICA, High Five America Club -10/U through High school

			Early Fee   Fee Standard Monthly Fee NA 95.00 Annual Registration & 1st Month Club (New Member) NA   185.00 Annual Registration NA   135.00 Misc. Club Fees NA   315.00
			Registrant Info   Fields with * are required   Registration Type *   Standard Monthly Fee Annual Registration & 1st Month Club (New Member) Annual Registration Misc. Club Fees Select one type Select age group *   10/U 11/U 12/U 13/U 14/U 15/U 16/U High school Hold CTRL key to select multiple options Choose Payment Method *   Visa MasterCard American Express Check or money order  Select payment method from the drop down list     Participant's First Name *     Participant's Initial     Participants Last Name *     Address *     City *     State / Province *     Zip Code *     Phone Number *   Use dashes and not periods. Include area code, example: 123-345-6789         Email address     Miscellaneous Info             Fax Number   Use dashes and not periods. Include area code, example: 123-345-6789 Birthdate *   Use slashes and not hyphens or periods. 01/01/2004 Gender *   Female Male   Grade level *   Pre School Kindergarten First grade Second grade Third grade Fourth grade Fifth grade Sixth grade Seventh grade Eighth grade Ninth grade tenth grade Eleventh grade Twelfth grade Undergaduate Graduate student NA           Medical / Emergency Contact Info             Waiver Info*   I understand the cost for enrolling my child in the High Five America club basketball program is $95.00 per month plus an annual, non-refundable registration fee of $135.00. These fees will provide my child with a uniform (jersey and shorts) and 2 practice sessions per week. Tournament fees and League fees are not included in these fees and will be charged separately High Five America is a 501 © 3 non-profit organization. Our purpose is to use sports as a means to speak out against drug and alcohol abuse, gangs and violence. I, the undersigned agree to allow my child to participate in the High Five America Basketball program. I/We hereby waive all claims which I might have against any of the sponsoring entities participating in the High Five America Basketball Program, their agents and employees for injury, accident, illness or death occurring during or by reason of this activity. I/We give permission to High Five America and any High Five America staff member to seek any medical attention required for my/our child. Accept waiver*   Disagree I agree
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