Player Information:
League *
9 and Under
10 and Under 11 and Under
12 and Under 13 and Under
14 and Under 15 and Under
16 and Under 17 and Under
Did your child play for the Celtics last year?
Yes
No
Date of Birth mm/dd/ccyy *
Age
Height Weight
First Name *
M.
Last Name *
Address
City
State Zip
AK AL AR AZ CA
CO CT
DC DE
FL GA
GU HI
IA ID
IL IN
KS KY
LA MA
MD ME
MI MN
MO MS
MT NC
ND NE
NH NJ
NM NV
NY OH
OK OR
PA PR
RI SC
SD TN
TX UT
VA VI
VT WA
WI WV
WY
Years of Celtics Participation
School
Player's Uniform Size *
Adult Small
Adult Medium Adult Large
Adult XLarge Adult XXLarge
Adult XXXLarge Youth Medium
Youth Large Youth XLarge
Shoe Size
Physicians Name
Physician Phone
Insurance Company
Policy #
Physical Restrictions/Disabilities
Parent Information:
Mother's Name *
Fathers's Name
Home Phone
Home Phone (if different)
Work Phone
Work Phone
Cell Phone
Cell Phone
Email address
Email address
Parent Registration Agreement:
Receipt Number * (with dashes)
There is a $250 donation to participate in the Atlanta
Celtics’ Spring and Summer Basketball Program. This fee
includes:
AAU Membership
Practice Uniform
1 Pair of Basketball Shoes
1 Travel Bag
Social Awareness Experiences
Basketball Skill Development
Donation is due at the time of registration. All donations
must be received before any of the above items or services
can be provided. No refund once shoes, and/or uniforms
are warned.
All players will be eligible for participation on the
travel teams, but all selections are at the coach’s discretion.
Parent/Guardian signature agrees to indemnify and hold
harmless the Atlanta Celtics, Inc., its Board of Directors,
Sponsors, Facility Owners and/or operators from claims,
demands and judgments arising at any time your child/children
are participating and/or traveling to participate with
the Atlanta Celtics Program. Further, I hereby grant full
permission to presenters of this program to use any photograph,
videotape, DVD recording, or any other record of events
for any purpose.
Parent/Guardian signature below attest your agreement
to adhere to all the rules and regulations of the facilities
events are held and that you have read this registration
form and grant full permission for your child to participate
in the Atlanta Celtics Basketball Program.
Parent/Guardian agrees to volunteer time during Atlanta Celtics sponsored local tournaments.
Initial