SYNERGY BASKETBALL RREGISTRATION: Fall 2022

Players Full Name *

Instagram Name: ex. @SynergyBBall

Birthday * +

Age *

Grade *

School *

SPECIALIZED PROGRAMS *

FREE TRIAL

TEAM SYNERGY: Option 1

TEAM SYNERGY: Option 2

TEAM SYNERGY: Option 3 - UNLIMITED

SKILLS & DEVELOPMENT: Option 1- YMCA (NH)

SKILLS & DEVELOPMENT: Option 2- Mill Works (MA)

SKILLS & DEVELOPMENT: Option 3- YMCA (NH)

SKILLS & DEVELOPMENT: Choose all 3 days (MA & NH)

XTREME

SPECIALIZED SHOOTING

MIX IT UP (D-UP, Offensive Attack & Game Situation)

3pc. COMBO - Wednesdays

PRIVATE LESSONS - 1 Lesson

PRIVATE LESSONS - 5 pack

PRIVATE LESSONS - 10 Pack

PRIVATE LESSONS - 2hr. Lesson

PRIVATE LESSONS - 2hr (5- pack)

PRIVATE LESSONS - 2hr (10- pack)

HOLIDAY CAMP (December)

MLK CLINIC

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

Youth: SM, M, L, XL, and Adult: SM, M, L, XL, 2XL, 3XL *

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. *