Home
About
7
Certifications
Contact
Mission
NY Rising Rebels
Terms & Conditions
Volunteer
Waiver
Coaches
Teams
Calendar
College Placement
4
Crafting a College Letter
Player Self Evaluation
Sample College Letter
Upcoming Events
Sponsors
1
Go Fund Me
Payment Form
Upcoming Events
Sign Up Here
Upcoming Events
Sign Up Here
info@nyrisingrebels.com
NY's 12U-18U
Developmental
Basketball Program
Home
About
Back
Certifications
Contact
Mission
NY Rising Rebels
Terms & Conditions
Volunteer
Waiver
Coaches
Teams
Calendar
College Placement
Back
Crafting a College Letter
Player Self Evaluation
Sample College Letter
Upcoming Events
Sponsors
Back
Go Fund Me
Payment Form
INITIAL
REGISTRATION FORM
To Get Started, Please Fill Out The Entire Application and Submit.
Our Team Will Review Your Application and Will Contact You Shortly.
PLAYER INFORMATION
FULL NAME:
SCHOOL NAME:
GRADE:
Please Select
9
10
11
12
Other
DATE OF BIRTH:
STUDENT CELL PHONE:
STUDENT EMAIL:
STREET ADDRESS:
CITY/STATE/ZIP:
PARENT NAMES:
PARENT EMAIL 1:
PARENT EMAIL 2:
PARENT CELL 1:
PARENT CELL 2:
BASKETBALL INFORMATION
PRIMARY POSITION:
Please Select
Point Guard
Shooting Guard
Small Forward
Power Forward
Center
SECONDARY POSITION:
Please Select
Point Guard
Shooting Guard
Small Forward
Power Forward
Center
DEXTERITY:
Right Handed
Left Handed
Ambidextrous
HEIGHT: (FT / IN)
WEIGHT: (LBS)
PREVIOUS INJURIES:
APPROX PREV INJURY DATE:
CURRENT INJURIES:
APPROX CURRENT INJURY DATE:
HOW DID YOU HEAR ABOUT US?:
Please Select
Online
Print Ad
Existing Client
Referral
Other
SECURITY:
SUBMIT
THANK YOU FOR YOUR SUBMISSION.
A REPRESENTATIVE FROM OUR TEAM WILL BE CONTACTING YOU SHORTLY.
Please turn on javascript to submit your data. Thank you!
© 2021
NY Rising Rebels Basketball
Designed by
Elevate Perception