Winchester Rising Stars
WinCity Basketball Association
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Athlete Information
Athlete Name
*
First
Last
Athlete Date of Birth
Date Format: MM slash DD slash YYYY
Athlete Grade
*
Select a Grade
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
School Type
*
Select a School Type
Elementary School
Middle School
High School
Private School
Elementary School Name
*
Select Elementary School Name
A.S. Rhodes Elementary School
Apple Pie Ridge Elementary
Armel Elementary School
Ashby Lee Elementary School
Bass-Hoover Elementary School
Blue Ridge Elementary School
Boyce Elementary School
C.W. Shipley Elementary School
D G Cooley Elementary School
Driswood Elementary School
E Wilson Morrison Elementary School
Evendale Elementary School
Frederick Douglass Elementary School
Garland R. Quarles Elementary School
Gainesboro Elementary School
Greenwood Mill Elementary School
Hilda J. Barbour Elementary School
Indian Hollow Elementary School
Inwood Primary School
John Kerr Elementary School
Leslie Fox Keyser Elementary School
Middletown Elementary School
North Jefferson Elementary School
Orchard View Elementary School
Page Jackson Elementary School
Ranson Elementary School
Redbud Run Elementary School
Ressie Jeffries Elementary School
Sandy Hook Elementary School
Shepherdstown Elementary School
Stonewall School
Virginia Avenue Charlotte DeHart Elementary School
W. W. Robinson Elementary School
Middle School Name
*
Select Middle School Name
Admiral Richard E. Byrd Middle School
Blue Ridge Primary School
Charles Town Middle School
Daniel Morgan Middle School
Frederick County Middle School
Harpers Ferry Middle School
James Wood Middle School
Johnson-Williams Middle School
Mill Creek Intermediate
North Fork Middle School
Peter Muhlenberg Middle School
Robert E. Aylor Middle School
Shepherdstown Middle School
Signal Knob Middle School
Skyline Middle School
Warren County MIddle School
Wildwood Middle School
High School Name
*
Select High School Name
James Wood High School
John Handley High School
Millbrook High School
Sherando High School
Skyline High School
Warren County High School
Mountain Vista Governor's School
Central High School
Strasburg High School
Stonewall Jackson High School
Musselman High School
Washington High School
Jefferson High School
Clarke County High School
Private School Name
*
Select Private School Name
Legacy Christian Academy
Sacred Heart Academy
Shenandoah Valley Christian Academy
Powhatan
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
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Ohio
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Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Medical Information
Does the athlete have allergies?
*
Yes
No
Alergies
Is the athlete currently taking any prescription medicine?
*
Yes
No
Medication
Reason for medication and frequency?
Health Care Information
Insurance Provider
*
Hospital Preference
*
Guardian Information
First Parent Name
*
First
Last
First Parent Email
*
First Parent Phone
*
Second Parent Name
First
Last
Second Parent Email
Second Parent Phone
Agree to Terms & Conditions
As the legal guardian, you must read and agree to ALL 3 documents below
Read the Winchester Rising Stars Refund, Playing Grievance
I have read and agree to the Refund/Playing Time/Grievance Policies
*
I Agree
Read the Winchester Rising Stars Release, Covenant Not to Sue & Assumption Of Risk
I have read and agree to the Release, Covenant Not to Sue, And Assumption Of Risk - Minor Participant
*
I Agree
Read the Winchester Rising Stars Waiver & Release of Liability
Winchester Rising Stars Waiver & Release of Liability
*
I Agree