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After School Program - Online Registration - 2017- 18' School Year

Choose the number of days per week. *
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Select your day(s) *
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Select the Month you would like to begin? *
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Transportation: Will your child need transportation from their school to our facility in Germantown? *
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Student-Athlete Information:
Child's Last Name: *
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Child's First Name: *
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Child's Cell Phone Number
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Current Age: *
Your answer
Current Grade Level: *
Fall of 2016
School Attending: *
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Parent/Guardian Information:
Parent Name(s): *
Your answer
Home Address: *
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Home Phone # *
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Cell Phone #: *
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Parent - Email Address: *
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Person(s) authorized to pickup child: *
Mother, Father, Aunt, Uncle, Etc...
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I hereby grant permission for my child to participate in HOOPS & HOMEWORK, Inc. program, including practices, games, training, and any events scheduled by the Program. I understand that I am responsible for my child’s insurance in case of injury. Furthermore, I understand that although the Program will observe safety precautions, the coaches and agents will not be responsible for any personal loss by my child or for any injury sustained in the Program and do not assume any liability for injury or damages arising from participation in the Program. I assume all liability for injury or damages during my child’s participation in the Program. *
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