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SPRING BREAK CAMP Registration Form
For
irls
G
&
Boys K - 8
s
Grade
HOOP CITY
681 Lawlins Rd. Wyckoff NJ
April 6 - April 10
9:00 am - 2:30 pm
Wyckoff
Brand New Facilty Across From Abma’s Farm
A Full Day of Non Stop Basketball
Come Work on Your Game @ Hoop City
Parent’s Name________________________________________________________________________________________
Child’s Name_______________________________________________________________________________
Address___________________________________________________________________________________________________
City_________________________________State___________________Zip___________________________________________
Phone_______________________________Cell__________________________________________________________________
Email(PLEASE PRINT CLEARLY)_____________________________________________________________________________
Grade __________________________School ____________________________________________________
PLEASE MAKE ALL CHECKS PAYABLE TO HOOP CITY LLC
Mail To:
HOOP CITY
681 Lawlins Rd Wyckoff NJ
You will receive an email confirmation once we receive your application.
Absoulutley NO REFUNDS WITHOUT a DOCTORS NOTE
$295 Per Week
$75 Per Day
I hereby authorize HOOP CITY LLC to act for me according to his/her judgement in any emergency requiring Medical Attention. I hereby release, discharge and indemnify HOOP CITY LLC
staff affiliated entities and their officers, agents and employees from and against any and all claims, liability, causes of action, lawsuits or awards arising out of or in connection with my or my
child’s participation in the program. I aslo give Hoop City LLC permission to use my child’s photo in promotional materials.
Signature:___________________________________________________________________________________________
Date:_______________________________________________________________________________________________