Registration: Kids Basketball

USER INFORMATION
Discount Code:
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone (515-XXX-XXXX):
Email:
Confirm Email:
How did you hear about this program?:
Participant's Name:
Date of Birth:
   
Gender:
Male  Female  
Grade:
Kindergarten  1st  2nd-3rd (FULL)  4th-5th  
List any allergies or medical conditions:
Parent volunteers are needed to make this program a success.
Select from the following if you are interested in volunteering:
Coach
Lead Provided Devotions
I'm not able to help at this time.
Release of Liability & Assumption of Risk
The use of the premises, facilities, equipment, and services at Ankeny First United Methodist Church naturally involves risk of injury to you or your guest, whether you or someone else cause it. As such, you understand and voluntarily accept this risk and agree that Ankeny First United Methodist Church will not be liable for any injury, including, without limitation, personal, bodily or mental injury, economic loss or any damage to you, your spouse, guests, unborn child, or relatives resulting from the negligence of Ankeny First United Methodist Church or anyone on Ankeny First United Methodist Church’s behalf or anyone using the facilities.

Type your name in this box that you agree to the above :