Child's Name

Please choose the week your child will attend.

S7: April 8 - April 17
S8: April 22 - April 29
S9: May 6 - May 17
S10: May 20 - May 31

MEMBER PAYMENT: Please select an option (If you have a valid membership)

GUEST PAYMENT: Please select an option.

Parent/Guardian #1: Name

Parent/Guardian #1: Relation to Child

Parent/Guardian #1: Cell Phone

Parent/Guardian #1: Email

Parent/Guardian #2: Name

Parent/Guardian #2: Relation to Child

Parent/Guardian #2: Cell Phone

Parent/Guardian #2: Email

Emergency Contact #1: Name

Emergency Contact #1: Relation to Child

Emergency Contact #2: Name

Emergency Contact #2: Relation to Child

Authorized to Pick Up

NOT Authorized to Pick Up

Medical Concerns & Allergies

By signing my name below, I acknowledge that I have read and understand the PROGRAM WAIVER, RELEASE AND INDEMNIFICATION AGREEMENT.

JHoops Registration S7-S10