Junior Hoopers House League 5v5 Scrimmage

STRIVE Hoops Inc.

Success Through Resilience, Integrity, Values & Excellence
Junior Hooper's House League

Ages 10-12
Athlete Information
Athlete's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Primary Phone Number
Alternative Phone Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact Name*

First NameLast Name
Relationship*
Phone Number*
Alternative Phone Number
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.*
*STRIVE Hoops Junior Hooper's House League runs August 6-27th. On Tuesday evenings from 6:00-8:00pm *Cost: $180. Please make payment via email transfer to: strivehoops@yahoo.com or cheque payable to STRIVE Hoops Inc. with your child’s full name in the comment section.
Is the athlete prescribed an inhaler? If yes, please explain any instructions.*
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by this organization, during the selected camp. In exchange for the acceptance of said child’s candidacy by this organization. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless this organization. All its respective officers, agents, and representatives from any and all liability for injuries to the said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against the organization. Including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include but are not limited to, the risk of fractures, or paralysis
Confirmation

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
E-Signature*

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Name

First NameLast Name
Phone Number
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Date

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Date
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STRIVE Hoops Inc.

Junior Hooper's House League

Athlete Information

Parent/Guardian Information

Emergency Information