registration

First Name Participant

Last Name Participant

Address

Date of Birth Participant

Email of Participant

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

Parent/Guardian 1 Email

Parent/Guardian 1 Phone

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Medical Issues

Emergency phone

Program: Select from dropdown

Purchasing package for skills sessions: Select from dropdown

Disclaimer: Must be checked for acknowledgement

I acknowledge that photos and videos taken at any Shake True Hoops / Ball4All events remain the property of Shake True Hoops / Ball4All. These photos may be used as promotional materials. I further acknowledge the inherent risks in sports and will not hold Stephen Cuevas, Shake True Hoops / Ball4All, or any staff/volunteers liable or responsible for any mishaps, injury or death resulting from participation in this program.