2018 WPC LITTLE HOOPSTERS APPLICATION
INSTRUCTIONS:
1. Please submit one (1) application for each child who will be participating in the WPC Little Hoopsters Basketball Program. Please be advised that your child has not fully registered until all of the following documents have been submitted and we have received online payment of $125.

2. Please fill out the following documents:
A. This WPC Little Hoopsters Application (please submit electronically)
B. Forms located in 2018 Handbook (please send in mail):
1. Player Information Form - on 2nd page of General Information PDF
2. Medical/Dental Treatment Release
3. Liability Release
4. Media Release
Please note that the Handbook is located on our WPC Little Hoopsters Website: http://wpcsportsministry.org/wpc-basketball/little-hoopsters-2/

3. Please submit an online payment of $125 for each child through Paypal or Credit Card/Debit Card by selecting the "Buy Now" Link located on our Little Hoopsters Website: http://wpcsportsministry.org/wpc-basketball/little-hoopsters-2/

4. Please email the Player Information Form, Medical/Dental Treatment Release, Liability Release & Media Release to info.wpclittlehoopsters@gmail.com.

*Spaces in our program are limited and are expected to fill up quickly, so please submit the online application, submit the online payment (Paypal or Credit Card/Debit Card and email the Player Information Form and Releases (3) right away.
** If you have any questions, please contact us at: info.wpclittlehoopsters@gmail.com

** There will be no refunds given after May 1, 2018.

Child's Last Name *
Please enter your child's last name
Your answer
Child's First Name *
Please enter your child's first name
Your answer
Child's gender *
Please select from the drop down list below:
Child's basketball experience *
Please select from the drop down list below:
Child's T-Shirt Size *
Please select from the drop down list below (please note that all T-Shirts are "Youth" sizes):
Child's Birthday *
Please enter your child's birthday (format - MM/DD/YYYY):
Your answer
Child's grade in Fall 2018 (not your child's current grade) *
Please select from the drop down list below:
Home address *
Please enter your house number and street:
Your answer
City *
Please enter your City:
Your answer
State *
Please enter your State:
Your answer
Zip Code *
Please enter your Zip Code:
Your answer
Primary phone number *
Format: ###-###-####
Your answer
Father's Email address *
Your answer
Mother's Email address *
Your answer
Father's first name *
Your answer
Father's cell number *
Format: ###-###-####
Your answer
Mother's first name *
Your answer
Mother's cell number *
Format: ###-###-####
Your answer
Emergency Contact/Relationship *
Your answer
Emergency Contact's phone number *
Format: ###-###-####
Your answer
Doctor's name *
Please enter the name of your child's doctor:
Your answer
Doctor's phone number *
Format: ###-###-####
Your answer
Health Plan *
Please enter the provider of your child's health plan
Your answer
Health Plan - Child's membership # *
Please enter your child's membership #:
Your answer
Please list any allergies and/or medical conditions for your child
Your answer
Do you currently attend church? *
Please select from the drop down list below:
If you currently attend church please indicate the name of your church
Your answer
I'm available to be a:
Please note that more than one (1) box may be selected.
(For 2nd Graders in the Fall) Is your child interested in playing for a Wintersburg basketball team this coming Fall?
Please note that basketball practices begin in October. The league runs from December to February.
Please indicate any special requests below:
Your answer
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