Team Genesis - Education
Books and Ball Registration Form
Student Athlete Name
Student Address
Student Phone Number
Student E-mail Adress
Person Registering
Parent
Student
School Staff
Please list particular subjects (if any) that student seeks tutoring in:
Name of High School Attending
Grade Level
Freshman
Sophomore
Junior
Senior
Sport (can list multiple)
Name of coach(es)
Parent or Legal Guardian Name
Parent or Guardian Phone
Parent E-Mail address
Emergency Contact
Emergency Contact Phone Number
Primary Time the Student Plans to Attend
Second Choice
Term
September-December 2011
January-April 2012
Student has Taken the SAT Exam
Yes
No
 


Please use the button above to pay the $15 registration fee per student.  For other payment options, please call our office at (434) 239-TEAM.

 
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