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FALL 2023 REGISTRATION SYNERGY BASKETBALL
Players Full Name
*
Birthday
*
+
Age
*
Grade
*
School
*
SPECIALIZED PROGRAMS
*
FREE TRIAL
TEAM SYNERGY: Option 1
TEAM SYNERGY: Option 2
TEAM SYNERGY: Option 3
TEAM SYNERGY: Option 4
TEAM SYNERGY: Option 5- Complete Player *UNLIMITED ACCESS
SKILLS & DEVELOPMENT: Option 1 (Tuesdays)
SKILLS & DEVELOPMENT: Option 2 (Thursdays)
MIX IT UP
3pc. COMBO
TEAM TRIPLE THREAT: Option 1 (Tuesdays-Haverhill)
TEAM TRIPLE THREAT: Option 2 (Thursdays-Bradford)
COMPLETE PLAYER
Additional Programs: Ex. SKILLS & DEVELOPMENT
Contact Information
1.) Parent / Guardian's Full Name
*
Email
*
Phone number
*
2.) Parent / Guardian's Full Name
Email
Phone number
Uniform Size
(Please specify-Youth or Adult sizes): S, M, L, XL, XXL
*
Preferred Jersey Number
Permission and Liability Waiver
As the parent or legal guardian of the above-named player, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of your child. I agree to hold Synergy Basketball, LLC harmless for any injury that may result from activities in the Synergy Basketball Program. I, the parent/ guardian assumes all risks and hazards incidental to the conduct of the Synergy Basketball Program activities. I also give my permission for the Synergy Basketball Program to publish, copyright, or use all films and photographs in which my son/ daughter is included for any exhibitions, displays, web pages and publications without reservation or compensation.
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