Basketball League Registration Form

Basketball Academy - Registration Form

Boys & Girls ages 10 -17

August 5 - 6 from 10am - 3pm

University City Campus of St. Joseph's University

(Formally University of the Sciences)

730 S. 43rd St. Phila, Pa 19104

For questions contact us a info@hoopdreamsinc.com or 267-319-5253

Athlete Information

Player Name*

First NameLast Name

Age*

Grade*

What school do you attend?*

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail*

Important Notes

· Dress appropriately.

· Must wear sneakers.

· FREE lunch provided.

· All athletes must stay until the end of the camp, unless we are notified by a parent.

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Does participant have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo

If Yes, 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 or Hoop Dreams staff for my child. I give consent for the facility to secure any and all necessary emergency medical care for my child.

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at St. Joseph's University's facilities may cause injuries and/or 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 coaches and staff of Hoop Dreams Inc. and St. Joseph's University.

Photo Release

I hereby grant permission to Hoop Dreams Inc. to record my childs likeness and/or voice on a video, audio, photographic, electronic, digital or any other medium and use his/her name in publications, news releases, online, and in other communications related to the mission of Hoop Dreams Inc. I release and waive any claims or rights of compensation or ownership regarding such uses and understand that all such recordings shall remain the property of Hoop Dreams Inc.

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

Signature

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 info@hoopdreamsinc.com