First Name:          Last Name: 

Address:   

City:       State:           Zip:  

Phone:      Cell Phone:

Date of Birth:  (mm/dd/yyyy)

School: 

Grade:     Height:     Parent's Names: 

Position:  1     2     3     4     5

Primary Email: 

Secondary Email:  (optional)

Notes:  
    

Programs:

***Waitlist Only***  CT Storm Basketball Clinic Directed by WNBA CT Sun Coach Scott Hawk
        February 18th & 19th for Grades 4-8 at $100
 

      CT Storm Spring Clinic beginning March 17th thru June at $575 ($300 deposit)

Groton Location

Putnam Location

Willimantic Location

Please pay online or make checks payable to "Connecticut Storm" and mail to:

Connecticut Storm, P.O. Box 826, Norwich, CT 06360

I hereby request my daughter named above be admitted to this CT Storm Program. I authorize CT Storm coaches to act for me according to their best judgment in an emergency requiring medical attention.  I understand that my daughter's participation in sports activities is potentially hazardous
and can cause injury or death. I clearly understand that by entering her name on this form that I am assuming all risk for any injury on or off the
court during her involvement. 

Parent/Guardian Full Name:    Initial:    Date: