Travel Player Registration Form

If you are interested in registering your child for our Traveling basketball program please complete and submit the following information. For information about fees see our player participation fee page.

Player Information

Please provide the following information about the player registering.

Select a Program *

Grade *

Player's Name *

Phone Number *

Address *

City *

State *

Zip Code *

Height *

Shirt Size *

Short Size *

Medical Information

Please provide the following medical information for your child.

Child's Medical Facility *

Doctor's Name

Phone Number

List any medical conditions.

Please include any comments that will help us understand your childs health condition(s).

Parent or Guardian Information

Please provide the following information.

Parent/Guardian Names *

Home Phone *

Cell Phone

Email Address *

Emergency Contact *

Relationship *

Phone Number *

Parent/Guardian Agreement *

I hereby agree to assume responsibility for any injury that may occur to my son/daughter in conjunction with this basketball program.

I do not agree to assume responsibility.

Coaching Information

Please complete the following fields if you or someone else you know is interested in coaching a team.

Interested in Coaching?

If Yes, please enter the person's name as the Head Coach Candidate or the Assistant Coach Candidate below.

Head Coach Candidate

Assistant Coach Candidate

Payment Information

Please select the payment method that will be used. After submitting this form you will have the option to pay electronically or send a check by mail.

Select a Payment Method *

Credit Card

Pay Pal

Mail a Check

Mail checks to Brainerd Basketball Association, Attn: Bruce Wiese, 4678 Forest Hills Circle, Nisswa, MN 56468

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