Hoops4Health Registration 3rd/4th Grade

Please fill out the form below to register your child for Hoops 4 Health for the 3rd/4th Grade Spring Section.

Child's Name*
First Last
Child's Grade*
Homeroom Teacher
Level*
Parent Name*
First Last
Parent Email*
Parent Cell Phone*
2nd Parent Name
First Last
Fill out only if they want to receive communications.
2nd Parent Email
2nd Parent Cell Phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
H4H 3rd/4th Registration Fee*
Price:
Total
$0.00
Other Comments
Payment Method

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

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