VICTORY ASSEMBLY
577 Albany Avenue, Brooklyn, NY 11203
VICTORY ASSEMBLY/NEW YORK KNICKS BASKETBALL CLINIC
REGISTRATION
Name: ________________________________________________________
Address: ________________________________________________________
Age: _____________________
Telephone: Home _______________________; Cell ______________________
Emergency Contact Information
Name: ________________________________________________________
Address: ________________________________________________________
Telephone: Home _______________________; Cell ______________________
Relationship (check one): Parent ____; Guardian ____; Sibling _____; Other _____.
PLEASE COMPLETE THE ACKNOWLEDGEMENT AND RELEASE OVERLEAF
