Backcourt Hoops & NEPA Flames Online Registration Form:

[Note: After submitting form, you will be taken to a screen from which you can pay online via safe, secure PayPal with your credit card or online check. You will also be given information on how to pay by check instead.]

Tournament Name:            

Tournament Dates            

Tournament Fee:           $ 

Team Name:                    

Team Street Address:    

City:                                   

US State:                               Zip:    

Boys or Girls Team     :    

Age   Group or Grade     :       Level (A,B orC if applicable):    

Coach's Name:                 

Coach's Email:                  (required)

Coach's Telephone:          (required) with area code

Coach's Cell  Phone:        (required) with area code

 

Comments/ Special Requests: we will attempt to honor your requests

     

       Player's Name                              Date of Birth             Number

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Additional players can be added via email
My players are in excellent physical health and capable of participating in strenuous physical activity, and waive Backcourt Hoops of any and all responsibilities for injury or illness. I hereby authorize the director of Backcourt Hoops to act for me according to their best judgment in any emergency requiring medical attention. I understand that each players parents are solely responsible for the payment of any such medical expenses. I also understand that my payments are non-refundable, non-transferable under any circumstances. By Pressing the submit button you agree to the above.

  Please wait it may take up to 30 seconds to process after you click submit  and go to confirmation page