Athlete First & Last Name

Guardian First & Last Name

Athlete Date of Birth (D.O.B.)

Athlete Phone

Guardian Email

Address | City | State | Zip Code

Guardian Phone

Clutchest Position

Most Challenging Position

Height

Weight

I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may disqualify my child from participating in the Crowned Clutch 3v3 basketball tournament.

My child and I understand that we must wear a mask during all non-competitive moments.

Have you, your child or anyone in your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit?

To the best of your knowledge have you or your child been in close proximity to any individual who tested positive for COVID-19?

Have you, your child or anyone in your household been tested for COVID-19?

Have you, your child or anyone in your household visited or received treatment in a hospital, nursing home, long-term care, or other health care facility in the past 30 days?

Have you, your child or anyone in your household traveled in the U.S. in the past 21 days?

Jersey Size

Short Size

Please Select Division

Grade Level

Name of High School

Date of Submission

ARE YOU HAVING TROUBLE?

No worries! Please email us at deliverwell@crownedclutch.org or give us a call at 844-748-0414