5280 Hoops Registration Form

$20.00 onetime tryout fee to be collected at the door. You will also have the option to prepay for tryouts at the end of this form.

Are You interested in playing *
Player's Name *
Player's Name
First Name Last Name
Player's Date Of Birth *
Player's Date Of Birth
What grade is the player currently in?
Player's Sex *
Player's Address *
Player's Address
Player's Phone *
Player's Phone
Home Phone
Home Phone
Mother's Phone Number
Mother's Phone Number
Father's Cell Number
Father's Cell Number
Emergency Contact *
Emergency Contact
First Name Last Name
Emergency Contact Phone *
Emergency Contact Phone
Emergency Contact Phone Number
Player’s Physician Name: *
Player’s Physician Name:
Physicians Phone Number: *
Physicians Phone Number:
AAU Insurance Information: Does the player have Health insurance? *