Mini Hoops Enrolment Form
Day & Location *
Age Group *
Form Details
Child Details
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Street Address *
Your answer
Suburb *
Your answer
Postcode *
Your answer
Parent / Guardian Details
Name *
Your answer
Relationship *
Your answer
Mobile *
Your answer
Email Address *
Your answer
Emergency Contact
(other than above)
Name *
Your answer
Relationship to child *
Your answer
Phone *
Your answer
Referral Name
Your answer
Referral Mobile
Your answer
Referral Email
Your answer
Medical information
For any ACTION PLANS please contact MyHoops Academy Coach
Conditions
Allergies
Your answer
Meidcation
Your answer
Dietary Requirements
Your answer
Payment
Apologies for any inconvenience, however cash payments can no longer be taken at our venues.
Payment method *
Amount
Dollar amount
Your answer
Card number
(If paying by credit card)
Your answer
Expiration date
(If paying by credit card)
Your answer
Name on card
(If paying by credit card)
Your answer
Security code
(if paying by credit card)
Your answer
Terms & Conditions
Disclaimer
All informatiom collected by MyHoops Basketball Academy is solely for the purpose of providing better and more efficient activities to our participants and keep them informed of all MyHoops Basketball services. We will obtain personal information from you. This will include contact details and may include sensitive corporate information that is necessary for the delivery of services to you. Please note by registering your interest with MyHoops Basketball Academy, you hereby acknowledge that MyHoops Basketball may use your personal or contact information for the above purposes or for our marketing purposes from time to time. In obtaining your information, we do so in strict accordance with the Privacy Act. In the event that you do not want to receive ongoing MyHoops Basketball information, all future correspondences will contain an option to unsubscribe.
First Aid Administration
I hereby authorise the staff/coach of the centre/venue and /or present during the period of the event to administer first aid and / or organise medical / hospital treatment as they see necessary, at my expense.
Responsibilty
I, and if being a minor, my parent/s, guardian/s, for and behalf of myself, understand that MyHoops Basketball will take no responsibility for accident, loss or injury suffered by myself /my child during the course of the activity.
Declaration
I declare that the stated person is physically and mentally fit to participate in all sporting activities for the length of the event.
Privacy Policy
MyHoops Basketball respects the privacy of all individuals we deal with in handling of personally identifiable information about individuals. We comply with the National Privacy Pricinples standards.

All information collected by MyHoops Basketball is solely for the purpose of providing better and more efficient activities to our participants and to keep informed of all MyHoops Basketball services. This will include contact details and may inlcude sensitive necessary for the delivery of services to you. Please note by registering your interest with MyHoops Basketball Academy, you hereby acknowledge that MyHoops Basketball may use your personal or contact information for the above purposes or for our marketing purposes from time to time. In obtaining your information, we do so in strict accordance with the Privacy Act. In the event you do not want to receive ongoing MyHoops Basketball information, all future corresponces will contain an option to unsubsrcibe.

Clothing Attire
All participants must wear comfortable appropiate for changing temperature and must bring a change of clothes.
Payment Methods
Upfront payment for each term is required prior to commencement unless giving an altertative payment plan approved by Coaching Director.
Unavailability of Facility or Services
As a requirement of enrolment, MyHoops Basketball participants/attendees/parents/guardians accept that a particular facility or service within Centre/Venue may be unavaliable at any particular time due to a prior booking, mechanical breakdown, fire, act of God and loss of leave, or any other reason. Therefore, MyHoops participants/attendees/parents/guardians agree not to hold the Centre/Venue responsible or liable for such occurences.
Hours of Operation
The Centre/Venue reserves the rights to vary, add or eliminate from time to time any of it's facilities or services.
Conduct within Centre/Venue
Management/ Coaching Director/Coaching staff reserves the rights to refuse entry, cancel enrolement, or request a student/participant/parent/guardian to leave the premises if that person does not behave in a responsible manner, is under the influence of durgs and/or alcohol or does not adhere to the conditions of use. MyHoops students are not permitted to leave the vicinity unless accompanied by the adult who has assigned the child in unless stated in written letter that another adult will pick the chile up.
Photo Release
This letter confirms the agreement between you and MyHoops Basketball, regarding your and/or your child/childrens participation in approved activities in which you / they may be photographed or videotaped (Property). The valuable consideration received, you hereby irrevocably grant to the above parties perpetually, exclusivley and for all media throughout the world (including print, nontheactrical, home video, internet and any other elctronical medium presently in excistence or invented in the future), the right to use and incorporate (alone or together with othet materials), in whole or in part, photgraphs or video footage taken of you as a result of your participations in approved acivities by MyHoops Basketball. You hereby that you will not bring or consent to others bringing claims or actions against the above parties on the grounds that anything contained in the property, or in the advertising and publicity used in connection herewith, is deflamatory, reflects adversity on you, violates any other rights whatsoever, inlcuding without limitation, rights of privacy and publicity. You hereby release MyHoops Basketball. its directors, coaches, officers, administraters, and assigns from and against any and all claims, demands, actions, causes of actions, suits, cost, expenses, liabilities, and damages whatsoever that you may hereafter have against the above parties in connection with the Property.
How did you hear about MyHoops? *
Agreement *
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