2017 Jordan Brand Classic Regional Player Information Page

(Please read all forms below and fill in your accurate information)

Player Information
Player Full Name *
Player Full Name
List hometown you want to be recognized
Player Home Address *
Player Home Address
Player Cell Phone Number *
Player Cell Phone Number
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Address *
Parent/Guardian Address
Parent/Guardian Cell Phone Number *
Parent/Guardian Cell Phone Number
Medical Information
Name on Policy *
Name on Policy
Emergency Contact *
Emergency Contact
Emergency Contact Cell Phone *
Emergency Contact Cell Phone
Name of Physician *
Name of Physician
Physician Address *
Physician Address
Physician Phone Number *
Physician Phone Number
Basketball Player Stats
High School Coach *
High School Coach
High School Coach Cell Phone *
High School Coach Cell Phone
Waiver Form
Playing Agreement Consent *
By checking the box I confirm that I have read and understand the playing agreement form attached below.