HOOPS 4 Life Basketball Academy Registration

HOOPS 4 Life Basketball Academy Registration

Register your participant for the HOOPS 4 Life Basketball Academy. Please complete all sections accurately. All information is confidential and used only for program purposes.
Participant Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Gender*
School / Team (if applicable)
Playing Position(s)
BeginnerIntermediateAdvanced
Participant Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Information
Parent/Guardian Full Name*

First NameLast Name
Relationship to Player*
Parent/Guardian Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email*
example@example.com
Parent/Guardian Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact
Emergency Contact Name*

First NameLast Name
Relationship to Participant*
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information
NoYes (please explain below)
Details of Medical Conditions, Allergies, or Injuries
NoYes (please explain below)
Medical Restriction Details
Insurance Provider
Insurance Policy Number
Program / Session Selection*
T-Shirt Size*
I give permission for my child’s photo to be usedI do not give permission
I have read and agree to the liability waiver
Parent/Guardian Signature*

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Participant Signature

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Date*

MonthDayYear
Date
I acknowledge and agree to the total program cost of $400, including the $50 non‑refundable deposit, and agree to make timely weekly payments of the remaining balance over the 12‑week program.
Should be Empty:

HOOPS 4 Life Basketball Academy Registration

Participant Information

Parent/Guardian Information

Emergency Contact

Medical Information