Hooperverse Registration Form

Nico Mannion Hooperverse Youth Basketball Leauge

Registration Form (Ages 8-14)

November 20th to February 27th Games Will either be anytime Saturday between 3 - 8 P.M. or Sunday's 10 A.M. - 8 P.M.

Location: TBD San Luis Obispo

Hooperverse Office - 173 Cross Street, San Luis Obispo - Hooperverse.com
Athlete Information
Child Birthday*
Gender*

MaleFemaleUndisclosed
Child’s Height *
Child Weight
Child Jersey Size (Ex. Youth Small)*
Player Name*

First NameLast Name
Guardian / Parents Names*

First NameLast Name
Guardian / Parents Names*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Cell Phone*

Area CodePhone Number
Parent Cell Phone

Area CodePhone Number
Parent E-mail*
example@example.com
Parent E-mail
example@example.com

Basketball skill level*

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Interested in Volunteering?

Match RefereeOperate ScoreboardCoachAdmissionSnack BarOther
I would like to play on the same team with following players. League organizers will form teams base on this buddy list and your skill level.
Emergency Contact & Health Insurance Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Do you have health insurance ?

YesNo, I'll pay with cash.
Insurance Carrier
Name of Policy Holder
Subscriver ID/Group Number
Card Number / Card Date
Do you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo
Please describe*
Parental Permission For Emergency Treatment In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child. I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Release of Liability Although the safety of all sport activities is the primary concern, indoor sport activities at Hooperverse facilities could lend to injuries and in unlikely cases lead to death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Hooperverse and the persons in charge.
I have read and agree to the above conditions*

YesNo
Confirmation E-mail*
example@example.com
Signature*

Clear
Fees*
prevnext( X )
Participant Fee$350.00

Total $0.00
Important Notes

Dress appropriately. No food or drink in the gym. Keep the gym clean. The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced.

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at lnfo@hooperverse.com !
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