Open House at Uchenna Academy – March 12, 2022

Registration form must be completed accurately and in its entirety to ensure a space is reserved for your child.

The application form will take about 5 minutes to complete.

Number of people attending the Open House Evet

1 (Student-athlete only)

2 (Student-athlete and 1 parent/guardian)

3 (Student-athlete and 2 parents/guardians)

Student Name (First, Last)

Date of Birth

Gender (optional)

Current Grade

Student Height (without shoes, cm or feet/inches)

Student Weight (lbs or kg)

Position on the team

Point Guard

Shooting Guard

Forward

Power Forward

Center

Student Phone Number

Student Email

Parent 1/Guardian 1 Name (First, Last)

Parent 1 Address

Parent 1 Phone Number

Parent 1 Email Address

AUTHORIZATION TO CAPTURE AND USE PHOTOGRAPHS

I consent to the use of photographs of my child as part of Uchenna Academy’s programs. These photos may be used on Uchenna Academy and their professional affiliates’ websites. The photos will serve the following purpose(s): to engage other youth into the various programs developed by the Uchenna Academy staff, raise awareness about Uchenna Academy and their courses, programs and initiatives. I agree that I shall have no claim against Uchenna Academy, their professional affiliates or against anyone accessing this product, whether online, in print or by any other means.

Name of person that completed this form

Open House at Uchenna Academy – March 12, 2022

Uchenna Academy High School

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