High school registration form | Proven Youth Basketball Club and Basketball League

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PART I: STUDENT INFORMATION

Student Name (First, Last) (required)

Date of Birth (YYYY-MM-DD)

Current School Grade

School Name

Math Grade (most recent report card)
A (80-100%)B (70-79%)C (60-69%)D (50-59%)Not Sure

Has the student ever been tested by external agencies (ex. Educational assessments, learning, speech, psychological)?
YesNoNot Sure

If yes, please explain

PART II: PARENT/GUARDIAN INFORMATION

Parent/Guardian Name (First, Last) (required)

Address (required)

Phone Number (required)

Your Email (required)

PART III: TERMS AND CONDITIONS

• REGISTRATION FEE OF $150.00 MUST BE PAID IN ORDER TO REGISTER AND IS NON-REFUNDABLE
• CANCELLATIONS MUST BE MADE IN WRITING TO QSLA – Attention: High School Administrator
• FEES ARE FULLY REFUNDABLE UP UNTIL 30 DAYS PRIOR TO THE COURSE START DATE.
• WITHIN 30 DAYS OF THE COURSE START DATE OR THEREAFTER, NO REFUND WILL BE ISSUED.

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