Queen City Youth Development
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Contact Information
If you are interested in becoming a part of the Queen City Youth Development family, please fill out all information completely and accurately.
First Name:
*
Last Name:
*
Parent's Name:
*
Date of Birth:
*
Grade:
*
Address Street 1:
Address Street 2:
City
:
Zip Code
:
(5 digits)
State:
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DE
DC
FL
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ND
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OR
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Parent's Phone
*
Cell Phone:
*
Email:
School:
Height:
Weigh
t:
Basketball Position
:
Top 5 College Choices
:
_______________________
OzieDavisIII@qcpdevelops.org
Founder & Board Chairmain
TimJohnson@qcpdevelops.org
Director
Queen City Youth Development
3550 Eden
Cincinnati, Ohio 45229
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