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First Name
Last Name
Date of Birth if player	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985
Age on Aug 1, 2009	10 11 12 13 14 15 16
Current Grade
Street Address
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State	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Cell Phone
Jersey	Select Jersey Size Adult X Small Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge

	E-mail
I understand that as a participant in Hoop Success™,   that my child is responsible for his conduct, proper use of the equipment  and facilities. I agree that the sponsors of this event will not be held liable or financially for any loss of personal property, bodily injuries, or the result thereof incurred and suffered by the applicant and members of their family. I understand and waive all financial claims that all images, whether photo, digital and/or video captured are the property of Hoop Success and may be used for promotional use. I understand that there are no refunds. I have read and accept the above disclaimer *All fields must be completed before consideration
Comments/Special Instructions