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Mississauga Basketball Academy
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Please complete the following registration form. Note: we will get back in touch with you to confirm your registration.
Payment is due immediately to reserve your spot in the program. Please mail cheque to Mississauga Basketball Academy, c/o 3555 Irwin Ct, Mississauga, Ontario, L5L 4W5. Upon completion of transaction, an email will be sent confirming acceptance into the registered program. If you are in need of assistance, email us at rebelsmba@gmail.com or call 647986-0221.
Athlete Information
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Indicates required field
Athlete / Child's Name
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First
Last
Gender
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Male
Female
Birthdate
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Grade
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Parent / Guardian information
Your Name
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First
Last
Email
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Phone 1
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Phone 2
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Address Line 1
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Address Line 2
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City
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Postal Code
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Choose From One of Our Current Runnin' Rebel Progams
Consent Agreement
REGISTRATION
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U19 SUMMER SESSIONS $130 FOR 8 SESSIONS
SUMMER WORKOUTS - START UP MONDAY JUNE 29TH THE VALLEYS 6;30-7;45 COST $130 FOR 8 SESSION
The participant is responsible for his or her own medical coverage.
I consent to follow all rules and regulations set out by the OBA regarding fair play and codes of conduct for both players and parents.
NO CLAIM - I hereby agree that I shall make no claim and bring no action, suit or proceeding for any and all damages, losses, liabilities or cost in any manner suffered or incurred as a result of my participating in the activities for which I have registered herein, and I hereby release the MBA and their administration, the City of Mississauga and the owner/occupier of the facility in which participate from any and all damages, losses, liabilities, or costs in this regard.
PHOTO RELEASE AND INDEMNITY - The MBA are authorized to take photos of my child or me at its programs for publicity and promotional purposes only. hereby acknowledge and agree that the MBA may use and disclose the information of this form to enable the MBA to provide membership benefits to all MBA members.
I consent to the MBA contacting me through email with regards to programs.
REGISTRATION: Confirmation of registration will sent upon clearance of cheque. Mail payments to Mississauga Basketball Academy, c/o 3555 Irwin Ct. Mississauga, Ontario L5L 4W5.
REFUND POLICY - Subject to administrative costs and is reviewed on an individual basis.
I AGREE
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Yes
Submit
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