Contact Coach Taylor
(707) 291-9161

Share this:

Please fill out the following form to register your player for the Express Basketball Club Program.

Parental Consent
By submitting this form, I hereby give my consent for my child to participate in all activities involving the Express Basketball Club. I declare that my child is in good physical condition. I give the staff of the Express Basketball Club permission to render such medical and hospital care as, in their judgment, may seem advisable for my child. I also state that we have adequate medical coverage and will not hold the staff of the Express Basketball Club liable for any injuries incurred during the camp session.

Express Basketball Registration Form

Please complete the information below.

Player Name * First Last
Parents Name * First Last
Parents Email *
Phone * - ### - ### ####
Current Grade *
Spring or Fall Session *
Date of Birth * / MM / DD YYYY
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Uniform Size (Adult) *
Emergency Phone * - ### - ### ####
Family Doctor Name * First Last
Family Doctor Phone * - ### - ### ####
Health Insurance Provider *
Policy No. *
Please list any physical disabilities