🏀 RISING STARZ ACADEMY

Basketball Registration Form

🧒Player Information

Full Name *

Date of Birth

Age

Grade (2026–2027)

School Name

Height

Weight

Primary Position

Secondary Position

👨‍👩‍👦Parent / Guardian Information

Parent/Guardian Name *

Phone Number *

Email Address *

Emergency Contact Name

Emergency Phone

📍Address

Street Address

City

State

Zip

🏥Medical Information

Any injuries or medical conditions?

Yes

✓

Allergies

Current Medications

🏀Basketball Experience

Years of Experience

Previous Teams / AAU

Strengths

Areas to Improve

⏱️Training Type

1-on-1 Training

Personalized, focused sessions with Coach J

Small Group Training

2–4 athletes, collaborative skill development

Speed & Agility

Athleticism, footwork, quickness & conditioning

💰Payment Option

Pay in Full

Payment Plan

📜Waiver & Consent

I, the parent/guardian, give permission for my child to participate in Rising Starz Academy activities. I understand the risks associated with sports training and agree to hold Rising Starz Athletes harmless from any injuries.

I agree to the waiver and give consent for my child to participate.

📸Media Release

YES, I allow photos/videos of my child for promotional use.

NO, I do not allow media use.

Questions? Contact Us

Rising Starz Athletes

📞 571-621-0979

📧 risingstarzathletes@icloud.com