Reach Basketball LLC

Child First Name (required)

Child Last Name (required)

Select PNO Date(s) your child will attend (required)
 January 27, 2012 February 24, 2012 March 30, 2012 April 13, 2012 May 18, 2012

Parent First Name (required)

Parent Last Name (required)

Contact Phone Number (required)

Your Email (required)

Assumption of All Risks and Release of All Claims:

In accordance with the Reach Basketball, LLC policy, I give my consent for the above named boy/girl to participate in all Reach Basketball, LLC activities. I also consent to Reach Basketball, LLC securing medical attention and/or transportation as deemed necessary in an emergency. I will not hold the Reach Basketball, LLC or any of the program volunteers or staff responsible for injury or liability and will secure adequate personal insurance for the duration of the program. Reach Basketball, LLC will not be responsible for medical costs. I recognize there are risks associated with strenuous physical exertion when engaging in basketball activities. I certify to the best of my knowledge my child’s physical condition is satisfactory to participate in physically demanding activities. I, the undersigned, have read this release and understand all its terms.

Check this box to accept terms:

Confirm all information above is correct then click the "Submit Registration" button below to submit your registration. Once registration is submitted, click the "Pay Now" button below to submit the registration fee payment. Please note that registration is not complete until fee payment has been received.