Registration for 2015 Sage Boys' Basketball Columbus Day Clinic

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Dates: October 12, 2015
Cost: $50
Boys' Ages 10-17

Parent/Guardian Name: *

Parent's Email Address:

Email address *

Athlete Name: *

Address: *

Phone: *

Age: *

Grade: *

Emergency Contact # 1 Information *

Name: Relationship: Phone:

Emergency Contact # 2 Information *

Name: Relationship: Phone:

There will be a $5.00 convenience fee to submit this online form.

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