Jordan Farmar Camp Registration

Number of Campers

How many Hoop Farm Campers are you registering? *

Camper 1 Information

Full Name *

Gender *

Male

Female

Age *

Shirt Size *

Skill Level *

Team Request (Optional) - We will do our best to accommodate team requests while maintaing fair and competitive teams in each age division. If you would like for your camper(s) to be on the same team as other campers, please indicate who you would like your camper(s) to be on a team with:

0/120 characters

Camper 2 Information

Full Name *

Gender *

Male

Female

Age *

Skill Level *

Shirt Size *

Team Request (Optional) - We will do our best to accommodate team requests while maintaing fair and competitive teams in each age division. If you would like for your camper(s) to be on the same team as other campers, please indicate who you would like your camper(s) to be on a team with:

0/120 characters

Medical Information

Medical Insurance Provider *

Policy Carrier Name *

Policy Number

Please note any medical conditions or injuries that the campers may have:

0/250 characters

Parent/Legal Guardian Information

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Confirm Email Address *

How did you hear about Hoop Farm? *

Is this camper a DCFS participant? *

No

Yes

Case Name: *

Case Number: *

Camper Date of Birth: *

CSW Name: *

CSW Phone Number: *

CSW Home Office Location: *

Waiver

I agree to the Terms and Conditions *

I certify that the foregoing statements are true and complete to the best of my knowledge and belief, and understand that any willfully false statements is sufficient cause for my application to be rejected.

I Agree to the Release & License Agreement *

I certify that by checking this box I have read and hereby agree to the Release & License Agreement

Do you have a Promo Code? *

Yes

No

Promo Code