Athlete Name*

Gender*

School*

2023-24 Grade*

Email Address #1*

Email Address #2 (optional)

Email Address #3 (optional)

Parent/Guardian Name(s)*

Street Address*

City, State, Zip Code*

Emergency Contact + Phone Number (cell)*

Number of weeks attending*

Please list the date(s) that you will miss. (vacation/conflict/etc)*

Please list any current or prior medical concerns or allergies that Hoops Training should have knowledge of:*

I authorize Hoops Training LLC employees to act in their best judgment in any emergency requirement of medical attention. I hereby release Hoops Training and the employees of the facility used in training from any and all liabilities for any injury or illness incurred while participating in a Hoops Training session or camp. I have no knowledge of any physical impairment that would be affected by the above named athlete participating in the Hoops Training program.*

Payment will be collected the first day that you attend.

Checks payable to HOOPS TRAINING, cash, or credit card payment sent via PayPal to AndrewDahl@HoopsTraining.com are accepted forms of payment.