Madison Hoop Dreams

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 Information
   
 
Starts:
Days of the Week:
Time:
Grades:
Size:
Location:
Cost:
 
Sign-up Form
 
Child's Name:
First  Middle Initial  Last
Sex:
Grade:
Height:   feet,    inches
Weight:  pounds 
Age:
  Level(s) of play:      
If varsity:
Parent's Name:
First  Middle Initial  Last

Address:

 

 (Street Address)
 (Apt, Suite)

City:  State:  Zip Code:
   
Home Phone: ( )  -
Emergency Phone: ( )  -   Ext. 
E-mail: e-mail is required for confirmation of the deposit and for further camp information
Confirm E-mail:
 
Insurance Carrier:
Policy Number:
Type the following verification code into the box below:
Verification
I give Madison Hoop Dreams Basketball Camp permission to publish in print, electronic, or video format the likeness or image of my child. I release all claims against Madison Hoop Dreams with respect to copyright ownership and publication including any claim for compensation related to the use of the materials. ***

 
*** Images of minors under the age of 18 are not identified under any circumstances. No names or information relating to the minor's identity are published. If you have any questions, please contact Coach Bill Barker at coachbarker@madisonhoopdreams.com.

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