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HoopKidz Registration Form

Name *

Email Address *

Grade *

Age and Date Of Birth

Address *

Parent(s) Name

Home Phone *

Work Phone *

Cell/Wireless

School Child Attends

Secondary Emergency Contact *

Location Of Registration *

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Liability Waiver: As a registrant/participant in HoopKidz Instructional Basketball and it's Summer Camps, you are agreeing that your child is in good physical condition and has your permission to participate in HoopKidz programs. HoopKidz and any person associated with it assumes no responsibility and will not be liable for any accidents resulting in medical/dental or other related expenses.