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Homenetmen Basketball Program Registration
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http://www.homenetmen-nj.com/
Participants First Name
*
Your answer
Participants Last Name
*
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Age
*
Your answer
Parent/Guardian Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone
*
Your answer
Email Address
Your answer
Name of Emergency Contact (Other than Guardian)
*
Your answer
Emergency Contact Phone
*
Your answer
Relationship to Participant
*
Your answer
Has the participant contracted Covid-19?
*
Yes
No
If "Yes", how long ago?
Your answer
Is the participant vaccinated for Covid-19?
*
Yes
No
T-Shirt Size
*
Youth L
Adult S
Adult M
Adult L
Adult XL
Please select if you want any further information on:
Scouts
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