2012/13 Youth
Basketball Registration
Circle the league you plan to play:
5-6 year old 7-8 year old 9-10
year old 11-12 year old
13-15 year old 16-18 year
old
Dribblers Biddy
Youth Junior
Elite
Senior
Grades:
K thru HS
Individual
$40 Team $280 (Scholarships Available)
Registration deadline is:
January 20th
$10 late fee after deadline
League play begins: February
3rd 8 Games guaranteed plus tournament.
League plays ends: Mid-April Dribble,
Pass, Shoot All-Star ContestMax
2 coaches per team
Friday Week Night Games (Saturday
as needed)
Interested coaches - Contact the league director! Game and Tourney Day Admission
Participant Information
Participant: _____________________________
Skill Level: Beginner ____ Intermediate ___ Advanced
____
Phone: ____________________Age: _____ Date of Birth: __/__/___
Shirt Size: YS YM YL AS AM AL AXL
Address: _________________City: _________________Zip:__________________
School: _____________________________________ Grade:__________________
Parent/Guardian
Information
Name:
____________________________ Relationship: __________________
Address: _________________ City: _________________ Zip: ____________
Phone __________________{ Work__________________ Cell___________________
Email ______________________
______ Parent or Guardian - check if you are interested in coaching-provide
name and contact info.
Name _______________________ Contact Info __________________________________
League Director: Dustin Harvey 765-543-8805 bluechipbasketball.net
Blue Chip Basketball Family Sports Center
3242 West 250 North
West-Lafayette, IN 47906 765-464-0100
