Name or Names :    

Street:  

City: State:     Zip: Phone:

cell:         Age:   Grade (if applicable ):    Gender Female Male

Birth Date:     E-Mail   HS School (if applicable ):

College  (if applicable ):
 

Membership and Pricing

One Week $20.00 Fitness Center includes Open Gym (basketball)  During regular open gym hours  Starts From Day Of Registration

 Youth (8th Grade and below)
1 Month $30   3 Month  $80  6 Month $140   1 Year  $260 Paid In Full  ------  if wanted 1 year paid monthly must be done in person

High School (9th-12th Grade )
1 Month $35   3 Month  $90  6 Month $160   1 Year  $300 Paid In Full  ------  if wanted 1 year paid monthly must be done in person

College (Full Time Student )
1 Month $40   3 Month  $100  6 Month $180   1 Year  $340 Paid In Full  ------  if wanted 1 year paid monthly must be done in person

Adult
1 Month $50   3 Month  $120  6 Month $220   1 Year  $420 Paid In Full  ------  if wanted 1 year paid monthly must be done in person

Senior Adult (62+)
1 Month $45   3 Month  $110  6 Month $200   1 Year  $380 Paid In Full  ------  if wanted 1 year paid monthly must be done in person

Two Adults
1 Month $75   3 Month  $180  6 Month $330   1 Year  $630 Paid In Full  ------  if wanted 1 year paid monthly must be done in person

Two Adults with Children in Household (Family)
1 Month $110   3 Month  $270  6 Month $450   1 Year  $750 Paid In Full  ------  if wanted 1 year paid monthly must be done in person

One Adult One Child    (each additional child per month $15.00 after first)
Registration must be done in person not on line

Total Amount  registering


I / we are  in good physical health and capable of participating in strenuous physical activity, and waive Excel at Backcourt Hoops of any and all responsibilities for injury or illness. I hereby authorize the staff at Excel at Backcourt Hoops to act for me according to their best judgment in any emergency requiring medical attention. I understand that I am solely responsible for the payment of any such medical expenses. I also understand that my payments are non-refundable, non-transferable under any circumstances.
Signature of Parent/Guardian By typing your name  you are giving an electronic signature Date:

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