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Elks Lodge #645 Hoop Shoot Pre-registration
Event Date: October 22, 20222

*Formal registration will take place the day of the event. You MUST bring a copy of your child's birth certificate.

Registration Times:
Ages 8-9: 8:30 AM
Ages 10-11: 10:00 AM
Ages 12-13: 11:15 AM

Event Address: A.S.K elementary School, 10 Route 209, Port Jervis, NY 12771

Contact: Caitlyn Gunderman at elks645hoopshoot@gmail.com

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Child's Name (First and Last) *
Child's Birthdate *
MM
/
DD
/
YYYY
How old will your child be on April 1, 2023? This age dictates their division.  *Child must be 8 years of age and no older than 13 years of age on April 1, 2023. *
Child's Gender *
Parent Email *
Parent's Phone Number *
Home Address *
I understand that I must bring my child's birth certificate. *
Required
I understand that I will have to complete the day of registration form. *
Required
I understand that I must arrive on time otherwise my child will not be permitted to participate. *
Required
I understand that my child should be properly dressed for the event (sneakers & gym attire), bring a bottle of water, and any medications (ie. inhaler, epi-pen) if needed. *
Required
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