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Hoop It Up Basketball Clinic Registration Form

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Participant Information

Contact Email *

Participant First Name *

Participant Last Name *

Participant Birthdate *

Participant Gender *

Female

Male

Country *

Street Address (w/Apt#) *

City *

State *

County *

Zip Code *

Phone *

Would you like to receive important event text alerts on this number (eg. changes or delays)?

Emergency Contact *

Emergency Phone *

Please select your County *

How did you hear about us? *

Who is authorized to pick up your child from the Clinic? (please list all below) *

Waiver *

I have read and agreed to the TERMS *

CLICK HERE TO VIEW THE TERMS.

Is the participant 18 or older? *

18 or older Under 18

Do you want to be added to our mailing list for updates on upcoming events?

Payment Details

Discount or Tracking Code

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Do not COPY & PASTE the code, please type it into this field.

Price

Discount (-)

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Total Owed

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