Athlete's Name

First Name

Last Name

Parent's Name

First Name

Last Name

Open Gym Dates

Check Dates you plan to attend

Open Gym 11/02

Open Gym 11/07

Open Gym 11/09

Open Gym 11/14

Open Gym 11/16

Phone Number

(###)

###

####

Birthday

YYYY

School

Position

Grade

Have You Played Club Before?

Please proceed to payment.

$10 for each open gym date, include athlete’s name in payment note.

Venmo: @Bill-Hitchcock

*Cash accepted at the door

Don’t forget your paperwork, which can be found here: https://www.psrvb.org/memberships (only 1 set of paperwork needed)