Primary Phone Number:
Alternate Phone Number:
First and Last Name:
Participant's Grade in School:
School Participant is Attending:
Select the activity in which
you would like your child to participate
Iddy Biddy Ballers ($60.00)
Tiny Tots ($60.00):
Pee Wee Hoops ($60.00):
*not offered this session
Personal Basketball Training:
Please contact for Appointment
Basketball Camps when offered
are only for half-days (9am to 12pm).
Columbia Orange Basketball Program:
Please contact us regarding
Columbia Orange membership
Is your child currently under a physician's care or on medication?
If yes, explain:
Are you a parent interested
Did you or your child coach or play in MSC's Leagues
type in which day you prefer to participate: Saturday or Sunday
Parent/Legal Guardian Signature:
Typing your name in the above field constitutes a digital signature.
Please note that NO Refunds.
MSC will credit participants for another activity if a situation prohibits
them from participation.
Copyright © 2013 Midwest Sports Academy. All rights reserved. P.O. Box 30172, Columbia, MO 65205.