(* denotes field is mandatory)

Player Details


Gender*:MaleFemale

Age*:

Date of Birth*: (in some browsers, reqd format is yyyy-mm-dd)

Nationality (required)

Ethnicity:

Address




Parent Contact Details


Other Details:
(Medical conditions, dietary requirements, allergies etc, if none add N/A)

Please advise in the text area below on your child's dates of attendance.

How did you hear about us?*:

Please advise if you have any objections to the player being included in promotional photography or videos relating to the camp or the club. Answer*:

I would like to receive updates about upcoming news and events and club information from City of Birmingham Rockets Basketball Club via,
SMSEmailTelephonePostI would not like to be contacted

TO CONFIRM ATTENDANCE, PLEASE PRESS 'SEND'.

After pressing "SEND" proceed to make the payment using the details below: Amounts are £12 per day or £30 for all 3 days.

Pay by Bank Transfer

Account Name: City of Birmingham Basketball
Account Number: 21487450
Sort Code: 40-32-03