JEBA Registration Form

Required

Player Namerequired
First Name
Last Name
Must contain a date in M/D/YYYY format
Parent/Guardian Namerequired
First Name
Last Name

Emergency Medical Information

Please list any medical conditions of which we should be aware​​

Waiver

The following must be read and signed by parent/guardian of ALL REGISTRANTS in order to participate:

In the event that my child needs medical attention, I authorize SouthLake Christian Academy and give my consent to its representatives to provide such service and/or to transport my child to a hospital or treatment facility. I hereby certify my child is in good health and may participate in all activities. My signature below indicates the agreement of the parent and the student to abide by the conduct policies. I hereby agree to the Enrichment refund policy. I also have read and understand the SouthLake Enrichment Program Policies and Guidelines.

Waiver agreementrequired
Must contain a date in M/D/YYYY format
Please read the waiver. Your printed name is your signature.​​

Payment Information

Multiple Choice

Payment Information

Provide an email address for the receipt.
Please select a payment typerequired
Billing Addressrequired
Cardholder Namerequired