Participant Information

* First Name

* Last Name

* Sex

* Age

* Shirt Size

* Medical Insurance Provider

* Policy Carrier Name

* Policy Number

Please note any medical conditions or injuries that the athlete may have.

* Skill Level: Please indicate the level of camper's involvement in organized basketball, if any, to help us create skill-appropriate teams (Example: AAU 3 yrs or City League 2 yrs)

Household / Adult Primary Contact

* Relationship to Participants:

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Zip

Phone

Alternate Phone

* Email Address

Each day, campers will be signed in and out by a parent or legal guardian. As per the agreement with UCLA and Hoop Farm Policy, campers can only be picked up by a parent or legal guardian unless otherwise notated or made known to staff. If it is likely that you may need someone besides a parent or legal guardian to pick up your son/daughter from camp, please indicate below the name(s), and relationship to the athlete, of anyone to whom you give permission.

Document Verification

All athletes are required to carry valid medical insurance and must also have a waiver signed by a parent or legal guardian in order to participate. Please mail the original copy of the signed waiver before July 31, 2010 to the address below.

Hoop Farm LLC
c/o Debra Heller
11835 W. Olympic Blvd. Suite 360
Los Angeles, CA 90064

View and Print Waiver

* I have printed out and completed the waiver, which I will mail to the address above

Confirmed

* Please select the registration period you are signing up during:

$425 Late Camp Registration

I plan to pay by:

Pay Pal (Credit Card)

Check

* Indicates Response Required