GRACE BOUND BASKETBALL

First Baptist Church-Owensville MO.

NOTE: Only parents, guardians, or other persons with legal parental authority over the child participant may complete this registration.

Contact Details Program Details Practice Nights: Mon / Tues
Becky Fernau 1st - 6th gradeFirst Practice: Week of 01/05
573-694-3972 Fees
fernaus7@gmail.com $25.00 First Game: 01/24/2026

Player First Name

Player Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Gender

Grade

Birthdate

Preferred Practice Nights

Monday

Tuesday

Parent/Guardian First Name

Parent/Guardian Last Name

Contact Number

Email

Preferred to be contacted by :

Phone Call

Text

Email

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Contact Number

Email

Would you like to volunteer?

None

Coach

Referee

Volunteer Shirt Size __________

Emergency Contact First Name

Emergency Contact Last Name

Phone Number

Notes and Special Request

AUTHORIZATION AND RELEASE OF LIABILITY

Signature

GRACE BOUND BASKETBALL

First Baptist Church-Owensville MO.

Our Purpose

Service Times

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