(This form for Individual Camps Only)

*This form is for the Virginia Fall Showcase Camp ONLY*

Please check http://www.hoopsanddreams.org after Sept 17, to confirm your registration.

There will be NO REFUNDS if you fail to show up on camp day.

Please fill out and print

Name (last) (First)

Address

City    State  -- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip

Home Phone  Email 

Date of Birth  / /             Position Played Height  ft. in.

School       Year of Graduation 

School Address  City 

State    Zip

School Coach  Coach's Phone # 

AAU Team 

AAU Coach  AAU Coach's #

Academic Profile

PSAT Score      SAT Score     ACT Score     GPA

Please complete the registration form, print a copy for yourself, and submit using the button at the bottom of the page.  Please complete and submit this form not later than two weeks prior to the event to ensure that your data sheet is in the publication that will be prepared for the college coaches in attendance.

Make your CERTIFIED CHECK OR MONEY ORDER payable to:  Hoops & Dreams

(No personal checks will be accepted) (Do NOT send cash by mail)

Mail certified check or money order with completed printed form to:

Hoops & Dreams

706 Rocksping Road

High Point, NC 27262

**  Be sure to include the player's name on the memo line of the certified check/money order.  **

Waiver

I hereby authorize the staff of Hoops & Dreams to act for me according to their best judgment in any emergency requiring medical attention, and I hereby waive and release Hoops & Dreams from any and all liability for any injuries or illnesses while at Hoops & Dreams.  I have no knowledge of any physical impairment that would be affected by the above player's participation in Hoops & Dreams, as outlined in the brochure.  I also understand that Hoops & Dreams retains the right to use photographs taken of players at Hoops & Dreams for publicity and advertising purposes.

(Must be authorized to participate)

PARENT OR GUARDIAN AUTHORIZATION 

DATE   / /

MM / DD / YYYY