Dec 21-23 Holiday Hoops Registration Form

Welcome to the registration form for the Second Wind Holiday Hoops Camp powered by XConnect! Please complete the form below to register for the December 21-23 Holiday Hoops camp. We look forward to seeing you at the Diamondback Energy Athletic Complex!
PLAYER INFORMATION
Player First Name
Player Last Name
Date of Birth

MonthDayYear
Date
Current Grade
School Attending
Gender

Other
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name(s)
Relationship(s) to Player
Email Address
example@example.com
Guardian(s) Cell Phone Numbers
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
List persons other than guardian(s) and Emergency Contact whom we may release your child to.
MEDICAL INFORMATION
Does the participant have any allergies?
Does the participant have any medical conditions?
Additional Medical Notes
MEDICAL AUTHORIZATION
Please read and review the Medical Authorization Statement
I have read and agree with the Medical Authorization Statement
LIABILITY WAIVER
Please read and review the Liability, Risk, and Assumption Waiver
I have read and agree with the Liability, Risk, and Assumption Waiver
CODE OF CONDUCT
Please read and review the Code of Conduct
I have read and reviewed the Code of Conduct with my player
LET US KNOW!
What is your child’s t-shirt size?
How did you hear about Second Wind?
PAYMENT

Little Ballers Morning Camp (K-3rd Grade)

$199.00

Future Stars Afternoon Camp (4th-12th)

$199.00

Enter coupon

Total

MEDICAL AUTHORIZATION