MC Hoops Basketball Camp 2017
This is the online registration form for MC Hoops Basketball camp taking place July 24-28, 2017.

Payment for the camp can be made in the following ways:
1. Mail a cheque payable to Maple City Baptist Church at 500 Indian Creek Rd. W. Chatham, ON. N7M 0P4 (Cost: 1 Child: $110; 2 children: $190; 3 children: $250; $60 for each additional child).
2. Paypal on the MC Hoops website by clicking the Paypal icon (credit card also accepted without Paypal account).
3. Cash or cheque in person at the church office (500 Indian Creek Rd. W., Chatham)
4. E-transfer payment to dchristiaans@maplecitybaptistchurch.com.

Once the form is complete, you will receive a confirmation within two weeks from Maple City. If you do not hear from us, please contact the church to ensure your child is registered. The number of registration accepted will be limited to the first 30 campers in each age group.

If you have more than one child attending, please fill each child's form out individually. After you have submitted the first registration, refresh the page to begin the second. If you have any questions about this form, please call Pastor Dan at 519-351-2004 or email dchristiaans@maplecitybaptistchurch.com. Thank-you. Please fill out this form in its entirety.

Visit: mchoops.com for more information.

Participant
YYYY/MM/DD
Your answer
Participant's Name
First & Last
Your answer
Participant's Address - House Number and Street Name
Your answer
Participant's Address - City
Your answer
Participant's Address - Postal Code
Your answer
Email Address
This email will be used to convey important information about the camp.
Your answer
Gender
Is anyone else in the family registering for MC Hoops this year?
This will help us apply the proper discounts
Grade in September 2017
Location and age groups are subject to change. Children will be moved to appropriate age and skill levels on the first day of camp if necessary or requested. Please call if you have any questions or requests.
T-Shirt Size
Additional t-shirts will be ordered and can be exchanged for a different size while they are available
Parent/Guardian Name(s)
Your answer
Relationship to the Child
Your answer
Parent/Guardian Telephone Numbers
Please list contact numbers in priority sequence
Your answer
Secondary Emergency Contact Name(s)
Your answer
Secondary Emergency Contact Telephone Numbers
Please list contact numbers in priority sequence
Your answer
Secondary Emergency Contact Consent to Pick-up
Please sign (digital signature) if your secondary contact will be picking up your child or they may come in case of emergency: I am the legal guardian of the child with full authority to make decisions with respect to the child. I confirm that the person listed as the secondary contact above is authorized to pick up my child during or at the end of the camp days; I hereby authorize you to release the child into the custody of the above individual.
Your answer
Medical Information: Name and Phone Number of Family Doctor
Your answer
Medical Information: Allergies
Please list any and all allergies the participant has and the usual treatment of these allergies (lunches are not provided, but nut-free snacks will be available throughout the week).
Your answer
Medical Information: Medications/Medical Conditions
Please list any medical conditions the staff of MC Hoops should be aware of as well as medication that the child will need to take during their time at camp.
Your answer
Medical Information: Does your child require?
Past Basketball Experience
Please select all that apply
Permission to Use Photos
By checking this box, I give permission for my child's picture to be used anonymously for advertising related to the camp and/or on the MC Hoops website
Digital Signature - Parent/Guardian
After you have reviewed this form, please sign below to give your child permission to attend MC Hoops Basketball Camp
Your answer
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