Student Information

Athlete First Name

Athlete Last name

Student Gender

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

City/Zip

Did a Coach refer you?

Jeremiah Williams

James Head

Carlos MedLock

Other

DEARBORN HEIGHTS, MI

Richard A. Young Center (Dearborn Heights)

5400 McKinley St, Dearborn Heights, MI 48125

Dates: Dearborn Heights

FARMINGTON HILLS/ NOVI, MI

Detroit Catholic Central HS

27225 Wixom Rd, Novi, MI 48374

Dates: Detroit Catholic Central

Player Evaluation

$25

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