All-Star Membership Registration – KOP

Shoot Hoops KOP - All-Star Registration

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Step 1 of 7

What type of Membership are you signing up for today?*

Individual

Family

Family Member Names (include parents and kids)*

First & Last Name

Gender

Date of Birth (xx/xx/xxxx)

Age

Grade

T-Shirt Size (S,M,L, XL)

Participant

Player's Name*

First Last

Gender*

Male

Female

Date of Birth*

YYYY

Age*

T-Shirt Size*

About Participant

Name of Participant(s) School*

Grade*

Years Playing Experience*

Goals for Participant(s)*

What day(s) / time(s) do you plan on attending weekly events?*

View our schedule. If on mobile, rotate phone to landscape to view full description

Parent Information

Name of Parent/Guardian*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Medical Information

Medical Concerns?

Name of Emergency Contact*

First Last

Emergency Contact Phone*

Relationship to Participant*

Additional Information

Any other information that you want Shoot Hoops, LLC to know?

How did you hear about Shoot Hoops, LLC?*

Family or Friend

Google

Returning Member

Other

Release and Waiver of Liability and Indemnity Agreement

(Read Carefully Before Signing)

In consideration of being permitted to participate in any way in the Shoot Hoops, LLC Program indicated below and/ or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree:

The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below Shoot Hoops, LLC activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agreed that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.
I/WE fully understand and acknowledge that:
- There are risks and dangers associated with participation in Shoot Hoops, LLC events and activities which could result in bodily injury partial and/or total disability, paralysis and death.
- The physical, social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe.
- These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named below.
- There may be other risks not known to us or are not reasonably foreseeable at his time.

Acknowledgement*

I have read and understand the Liability and Indemnity Agreement

Parent or Guardian Signature (if minor)*

Name of Parent or Guardian Signature*

Date*

MM slash DD slash YYYY

Payment

All-Star KOP Membership

Price:

Credit Card

Card Details

Cardholder Name

All membership plans renew automatically every 30 days. To cancel membership, please email office@shoothoopspa.com