BOOKS & BASKETBALL MENTORING PROGRAM REGISTRATION FORM 2023

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Complete this form in its entirety and then Submit. A separate form must be submitted for each student.

Fields with a red asterisk * are required fields.

Event Address: 313 Gale Street. Aurora, IL. 60506
Contact us at 630.606.1910 or 630.476.0171

Email *

Participant Name *

Address, City, State, Zip *

Primary Phone Number *

Age (7-15 years old only) *

Date of Birth *

YYYY

Gender *

Male

Female

Ethnicity *

School *

Grade *

Does the student participate in the Free Lunch Program

Yes

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