Membership Adjustment Form

Membership Adjustment Form
Player Information

Please fill out this section completely.
Player Name*

First NameLast Name
Age*
Gender*

MaleFemale
Grade*
Parent Information

Please fill out this section completely.
Parent Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
General Financial Information

Fill out the corresponding sections that best describes your situation.
How much is the monthly membership you are applying for? (Ex: Silver Clinic Membership - $120, Club Team Membership - $350)*
Clinics - $120/$150 | Club Team - $350
How much can you afford for this monthly membership?*
Other Circumstances (Optional)

In the Space below (or typed on a separate page, or in an email), please describe any other reasons or circumstances (past, present, or future) that you feel increase your qualification and/or need for financial assistance at Hoop Code (e.g., family circumstances, academic standing, ministry or other responsibilities; etc.).
Reason or Circumstance:
Conditions Upon Acceptance
If your application is accepted, understand that the scholarship & financial discount offered to you from Hoop Code is conditional and that to continue receiving the same you (and the awarded player) must:

a. Maintain credible behavior and conduct in accordance with Hoop Code standards.

b. Payments must be on time. Any unsuccessful payments or past due accounts must be rectified within one week.

c. Inform Hoop Code administration when the need for adjustment no longer exist.
Signatures
I affirm that the information in this form is true and accurate according to my knowledge.
Parent Signature*
Type Full Name
Date*

DayMonthYear
Should be Empty:

Membership Adjustment Form

Player Information

Parent Information

General Financial Information

Other Circumstances (Optional)

Conditions Upon Acceptance

Signatures