Monday, February 27, 2017
 Upward Registration:
Welcome to Upward! Please fill in all the required information below so that we can properly register your child for our upcoming Upward event.
* = Required Field
Child's Last Name:*
Child's First Name:*  
Street Address:* 
Zip Code:*  
Home Phone:*  
Parent's Cell Phone:*  
Email Address:*   
Re-enter Email:*  
Church (If you regularly
attend church, which one?): 
Child's Gender:*
Child's Grade:* 
Child's Date Of Birth:*
Years Experience Participating in
Organized Basketball:* 
None 4
5 or More
Is There A Day Your
Child Cannot Practice
Monday Tuesday
Parent/Guardian (1) Information:
Parent/Guardian First Name:*
Parent/Guardian Last Name:*   
Relationship To Player:*   
I Can Support The League As: 
Referee        Coach
Asst Coach Volunteer
Parent/Guardian (2) Information:
Parent/Guardian First Name:
Parent/Guardian Last Name:   
Relationship To Player:   
Home Phone:   
I Can Support The League As: 
Referee        Coach
Asst. Coach   Volunteer
Emergency Contact Information: 
Emergency Contact First Name:*
Emergency Contact Last Name:*   
Emergency Contact Home Phone:*   
Emergency Contact Work Phone:*   
Emergency Contact Cell Phone:   
Place Here Any Additional Player Information Notes For Registration: 
Carpool/Coach Link -
Please enter Carpool Child's Name/Coach's Name:
Child's Shirt Size:


Liability Waiver Release Statement:* 
I Have Read And Accept The Liability Release Agreement:
 Yes                No

Please Download and Read Carefully→

Please Read Carefully: 
Does this child have any disabilities, handicaps or present injuries or limitations, allergies, hemophilia, heart conditions, history of respiratory illness, or any other significant medical condition?*
 Yes              No
If Above Answer Is Yes,
Please Explain Here: 
Form of Payment:
 Online        In Office
 (please click submit before continuing to payment) 

To pay online now through our secure online payment option, please click the link below. (ACH Payment option only, no credit/debit cards accepted)
Cost: $95
Deadline for registration is March 17, 2017     

To pay by check or cash, please drop off registration fee by the church
office Monday through Friday, between 8:00 am and 5:00 pm.