Registration Form
Personal Information
Name:
Street Address:
City:
State:
Zip:
Phone Number:
Email Address:
Date of Birth:
Age:
T-Shirt Size:	S M L XL XXL
Security Information
Parent's Name:
Person Checking Player In & Out:
Emergency Contact Name:
Emergency Contact Phone Number:
Medical Information
Health Insurance Company:
Member ID:
Insurance Phone Number:
Pre-Existing Medical Conditions:
Current Medications:
Allergies:
Basketball Information
Rank the fundamentals below from 1-4, with #1 being the area needing the most improvement.
Defense / Conditioning	1 2 3 4
Shooting	1 2 3 4
Passing	1 2 3 4
Ball Handling	1 2 3 4
Strengths:
On a Basketball Team?	Yes No
Name of Team:
Basketball Goals:
What do you want to learn most from the clinic?
Are You Interested in One-One Training?:
Submit Form

 

Summer Camp Registration Area

This area is for summer camp registration only. Currently, there are no camps scheduled. Be sure to visit us again for upcoming event information. Email us to be added to the Hip Hoop mailing list and we will notify you of updates automatically.

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