Last Name (athlete) *:

First Name (athlete) *:

Street Address *:

City *:

State *:

Zip Code *:

Phone Number *:

Email (for confirmation):

Parent/Guardian *:

Parent/Guardian Phone *:

School Athlete Attends *:

Grade (in or coming out of) *:

Event Attending *: - Select - Lil Dribbler Winter Early Session Lil Dribbler Winter Later Session

Event Location *: - Select - Clare Church of the Nazarene

Event Start Date *: - Select - January 16th (Monday)

T-Shirt Size *: - Select - YS YM YL AS AM AL AXL

Gender *: - Select - Male Female

Comments/Medical Info:

How Did You Hear Of Us: - Select - Friend Flyer Newspaper Email Other

Fee *: - Select - $40.00 (Normal Fee after Jan 1st) x
Early discount price if registered AND paid up to January 1st!

You may want to print this form for your records before hitting the Buy button below which will take you to the shopping cart for checking out.

If adding more than one athlete you can hit the back arrow on your browser bar in the cart to come back here and modify this form to submit a second athlete.
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(Payment options at checkout)