Online Registration Form

Family Information

Parent/Guardian Name:
Spouse/Partner: New Member Returning Member
Street Address: City: ZipCode:
Home Phone: Cell Phone:
Parent/Guardian's Place of Employment:

Email: Email is our primary source of communication at Holt.

Player Information

Registering for:    Micro (ages 3&4)     Youth Basketball (ages 5-17)   

Player Full Name:
Age: Date of Birth: Female Male
Age groups determined by player's age on 9/1/12.

Shirt Size: Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult ExtraLarge Adult ExtraExtraLarge    IMPORTANT: Order sizes CAREFULLY - $15 for wrong-sized shirt

What school does your child attend?

Other Information

Want to coach? YES Head coach or asst, specify ages:
NOTE: Coaching is rewarding and exciting and we have lots of support for the first-time coach. We count on parent coaches for many of our teams. In the event we do not have a coach for your team, we will beg for parent volunteers. In the rare and extreme case where nobody steps up, the team will be disbanded and monies refunded. We hope you volunteer with us!

How did you hear about Holt Basketball? check all that apply

Additional Comments:

Waiver

"I waive, release and forever discharge, and hold harmless Holt Athletic Association and its Board of Directors, Coaches, and Officials from any liability, claims, demands, actions, and causes of actions whatsoever arising out of or related to any loss, personal injury, or property damage that may be sustained during participation in any sport program of Holt Athletic Association. I further understand that my registration is NOT complete until I submit payment and no guarantee is made that my child will be placed on a team without payment. I understand no refunds are given after evaluations and team formation."

<---Check box to agree to Waiver

By pressing the Submit Registration button below, you hereby agree to the Waiver as stated above. Please note your child is NOT registered until payment is received.