ROBERT ICART – BTI DIRECTOR

 BASKETBALL PRIVATE SKILL TRAINING

BTI Center/Pasadena Boy’s & Girl’s Club

2020 N Fair Oaks, Pasadena, CA 91103

Registration Form (print using the print icon above): 

Name:____________________________________ Home/Cell #: ________________________________

Address:_____________________________________________________________________________

City:  ______________________________________ State: ________ Zip: ________________________

School:_____________________________________Grade:____________Birthdate:________________

Parent Email: ___________________________ Player Email: __________________________________

I hereby authorize the staff of the Basketball Training Institute to act for me to their best judgment in any emergency requiring medical attention I hereby waive and release BTI from any and all liability for injuries or illness incurred during the clinics. I certify that I am medically fit to participate and have no knowledge of any impairment that would affect me to participate.

Athlete _______________________ Parent/Guardian __________________________ Date __________

Emergency Number __________________ Health Plan __________________ Policy # ______________

Private Lesson Packages:

Payment Method (Circle One):

CASH/CHECK/CREDIT CARD: __ VISA __ MC __AX

CC # ________________________________ CVV _________EXP Date _________

Pay online (be sure to put Offensive Skills with your son's name) or make checks payable to: BTI - P.O. Box 91459 Pasadena, Ca 91109 Phone:  818-797 -8112