Junior Rebel Athletics Basketball - Registration - Milwaukie, OR
Junior Rebel Athletics Basketball -  JRA Keys to Success: Hard Work, Self Confidence and Patience.
General Registration
 Please use the form below to register your athlete for any of our great programmings. Just choose the programming you wish to register for and enter your information. If you have any questions or you are in need of any assistance please contact John Reese at johnr@jrabasketball.com. 
Skills Academy or Intensity Clinic Training
Punch Card Options
JRA Competitive Team (Choose One)
Payment Option (This option is for registrants participating on a competitive team)
Athletes First Name
Athletes Last Name
Gender
Male
Female
Birthdate
Grade Level This Fall
Parent First Name
Parent Last Name
Email
Second Email (Optional)
Day Time Phone
Cell Phone
Address
City
Zip
Team Apparel Option
JRA Team Jersey - $30
JRA Team Shorts - $30
JRA Team Shooting Shirt - $35
Players Shirt Size
Players Shorts Size
Name you wish to have printed on your shooting shirt.
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone Number
Relationship
Referred By
Medical Comments (Please list any allergies, special meds or special concerns here)
ACTIVITY RELEASE OF LIABILITY READ CAREFULLY. THIS AFFECTS YOUR LEGAL RIGHTS. I herby waive and release, hold harmless and forever discharge Junior Rebel Athletics (JRA) and all its agents, employees and affiliates of and from all claims, demands, causes of action, damages and liabilities of every kind and nature, arising from or in any way related to my son or daughters participation in any of the events or activities conducted by JRA. I understand that the activities in which my son or daughter will participate are inherently dangerous and can cause serious injury including bodily injury, damage to personal property. I waive all claims of injury to my son or daughter’s body and or property that I may have against the aforementioned company pertaining to such activity, including claims in tort, contract, equity, or otherwise. I acknowledge, agree and represent that I understand the nature of the training and its activities and that my son or daughter is qualified, in good health, and in proper physical condition to participate in the related activities. My signature on registration page is proof of my intention to execute a complete an unconditional waiver and release JRA of all liability to the fullest extent of the law. I am at least 18 years old and the legal guardian of the child named on this registration form and I am mentally competent to enter into this agreement. Please enter parent/guardian full name in the box below as this will act as your legal signature.
Financial Aid (A separate form will be emailed. Qualifications will be based on family meeting eligibility requirements)
Yes
No


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