Shot Doctor Registration.
Shot Doctor
Please Print Below
Name__________________________________________________________________
Address________________________________________________________________
______________________________________________________________________
Phone # _____________________
Emergency phone or Cell #_________________
Address______________________________________________________________
Age ____________ Grade _________Gender ___________
School __________________________________________
Parent/Guardian Name_________________________________________________
Please check box
□ Introductory Fee $25 □ Single Session $40 □ Block of 3 hours $100
Best day and Time to Train ____________________________________________________________
I, the adult applicant, _____________________________________________ Date_________________hereby give approval for the applicant’s participation in and any Hopewell Basketball program;I will not hold the organization and sponsors, their employees and associated personal, including owner of fields and facilities utilized for the programs against any claim by or on behalf of the registrant as a result of the registrant ‘s participating in the program and/or being transported to or from the same, which transportation. I give permission to the Hopewell Basketball Association to use photographs of myself and /or my child for historical archives, educational, and promotional purposes. These materials may be used for immediate of future use. I understand that there is no remuneration and that the pictures will not be used for commercial purpose.
Mail Checks to Bob Alton, 102 Search Ave, Pennington NJ 08534 Attn. Shot Doctor.