Hoop Heroes Registration

Name*

First NameLast Name

Age*

Grade*

School*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Child's Race*

Phone Number*

Please enter a valid phone number.

Parent's Email*

example@example.com

Is your child on any medications?*

NoYes

If yes, please explain.

I authorize camp staff in any emergency situation to administer basic first aid for health or welfare reasons.*

YesNo

I give Five Ducks Academy and Five Ducks Foundation Permission to photograph and/or videotape my child for public relations and/or marketing purposes.

YesNo

Pay for Program*

Hoop Heroes (One Month)

$70.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Cash App Pay

Afterpay

Discipline Policy see parent handbook for more details: 1. Verbal Warning and the warning will be documented. Parents will be notified at pick-up time. 2. Written Warning: A report of the incident will be written, and parents will be notified. 3. Suspension: Suspension from the camp program will be an automatic consequence for behavior such as fist fighting, physical/verbal coercion and destruction of property. No refunds or credits will be given for time missed due to disciplinary action. I agree.*

YesNo