Duchesne City Recreation
             
Jr. Jazz Basketball - Fall 2018
PreK - 8th Grade

****NO REFUNDS****

Registration is Tuesday, Sept. 25th - Sunday, Oct. 14th @ 11:45 pm.

Each child will receive a FREE Duchesne Recreation basketball t-shirt and get the opportunity to learn the game of basketball.
All practices and games will be played in Duchesne Elementary School, Monday - Thursday evenings. Season starts October 29th and ends December 13th. Practice times will depend on the coach's schedule. Games will start at 5:30 pm.


Participant:   $30.00   Quantity:   Item Subtotal:  
$0.00
Participant's Name [1]
Age [1]
Gender [1]
Grade [1]
T-Shirt Size [1]
Requested teammate(s) [1]

Participant's Name

[2]
Age [2]
Gender [2]
Grade [2]
T-Shirt Size [2]
Requested teammate(s) [2]

Participant's Name

[3]
Age [3]
Gender [3]
Grade [3]
T-Shirt Size [3]
Requested teammate(s) [3]

Participant's Name

[4]
Age [4]
Gender [4]
Grade [4]
T-Shirt Size [4]
Requested teammate(s) [4]

Participant's Name

[5]
Age [5]
Gender [5]
Grade [5]
T-Shirt Size [5]
Requested teammate(s) [5]

Participant's Name

[6]
Age [6]
Gender [6]
Grade [6]
T-Shirt Size [6]
Requested teammate(s) [6]

Participant's Name

[7]
Age [7]
Gender [7]
Grade [7]
T-Shirt Size [7]
Requested teammate(s) [7]

Participant's Name

[8]
Age [8]
Gender [8]
Grade [8]
T-Shirt Size [8]
Requested teammate(s) [8]

Participant's Name

[9]
Age [9]
Gender [9]
Grade [9]
T-Shirt Size [9]
Requested teammate(s) [9]

Participant's Name

[10]
Age [10]
Gender [10]
Grade [10]
T-Shirt Size [10]
Requested teammate(s) [10]

Extra Items

Picture(s):   $12.00   Quantity:   Item Subtotal:  
$0.00
Jersey:   $10.00   Quantity:   Item Subtotal:  
$0.00
Jersey Size [1]

Jersey Size

[2]

Jersey Size

[3]

Jersey Size

[4]

Jersey Size

[5]

Jersey Size

[6]

Jersey Size

[7]

Jersey Size

[8]

Jersey Size

[9]

Jersey Size

[10]
*All kids must have a jersey but can use old one from past seasons.
Shorts:   $12.00   Quantity:   Item Subtotal:  
$0.00
Shorts Size [1]

Shorts Size

[2]

Shorts Size

[3]

Shorts Size

[4]

Shorts Size

[5]

Shorts Size

[6]

Shorts Size

[7]

Shorts Size

[8]

Shorts Size

[9]

Shorts Size

[10]
New dry fit panel Jazz shorts - Color green
2 Tickets Package For The Player:   $24.50   Quantity:   Item Subtotal:  
$0.00
1 Ticket Package For The Player:   $19.00   Quantity:   Item Subtotal:  
$0.00
Extra Jazz Ticket For Family (Each):   $22.00   Quantity:   Item Subtotal:  
$0.00
Total:
$0.00
 

Would you like to help with any of the following?
Coach
Assistant Coach
Team Parent
Parent/Guardian Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
In Emergency Notify
Emergency Phone Number
Payment Information
Method of Payment:
Update name from Parent/Guardian Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number:
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Parent/Guardian Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:
I hereby certify that my child/children are in good health and capable of participating safely in the Utah Jazz Basketball Program and have accident and health Insurance and the community Recreation Department and all other participating agencies are not liable for any accident while participating in the Utah Jazz Basketball Program. I hereby authorize the Directors of the Utah Jazz Basketball Program to act in my behalf in accordance with their best Judgement in case of Emergency. I understand the goals and objective of the Utah Jazz Basketball Program which are based on fun, fair play, skill development and teamwork. I as a Parent or Guardian, Understand there will be NO REFUNDS.
         I have read and agree to the above disclaimer
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