Fall Travel Team

Fall Travel Team

Please fill in the form below.
Player's Name *

First Name Last Name
Parent's Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone *

Area Code Phone Number
Emergency Cell *

Area Code Phone Number
E-mail *
Gender *
D/O/B *

Month Day Year
Date
Grade *
School *
New Player $495
Uniform Size
Returning Player $445
Uniform Number
Player Fee *

$15 Tryout fee (non-refundable) $595 (New player) $545 (Returning player with Angels uniform)
Player Fee (must select two) *

$10 Tryout fee (non-refundable) $445 (Returning player with Angels uniform) $495 (New player)
Payment *

Cash/Check (payable to Hoop Heaven Georgia and mail to 78 Ridge Road, Canton, GA 30114) Credit card ($20 processing fee - you will receive an invoice to pay online)
Liability, Waiver, Release, Limitation of Damages

I hereby authorize the agents of Hoop Heaven Georgia to act for me accordingly to his/her best judgment in any emergency requiring medical attention. I hereby release, discharge and indemnify Hoop Heaven Georgia, Tiara Simpkins, Hopewell Baptist Church, River Church, Lyndon Academy, Northeast Cobb League affiliated entities and their officers, agents and employees from and against any and all liability or causes of actions arising out of or in connection with my child’s participation in any Hoop Heaven Georgia program, league, tournament, and our attendance at on-site and off-site premises. I give Hoop Heaven Georgia permission to use my child’s photo and/or video in promotional materials.
Date *

Month Day Year
Date
Should be Empty: