Hoop Dreams London Basketball Half-term/Holiday Camps Registration Forms If you are human, leave this field blank.2023-24 Hoop Dreams London Half-term/Holiday Basketball Camp Registration/Payment Form This online form is a lot simpler and and quicker to complete. All forms will be sent to the Hoop Dreams online Registration database. If parents have any questions please feel free to email the Hoop Dreams London basketball camp coordinator/coach: lekan@surreyrams.net PLEASE NOTE OCTOBER 2023 CAMP LOCATION: 23RD – 26TH OCTOBER 2023 – ASH MANOR SPORTS CENTRE, MANOR ROAD, ASH, SURREY GU12 6QH CAMP TIMES: 10:00 – 15:00 2023-24 HOOP DREAMS LONDON HALF-TERM/HOLIDAY BASKETBALL CAMP COST ARE: 1 day camp package:£30.00 2 day camp package:£60.00 3 day camp package:£80.00 **3 DAY DISCOUNT** 4 day camp package:£100.00 **DISCOUNT** *AS WE ARE MAKING A COMMITMENT TO COACHES AND FACILITIES THE ABOVE FEES ARE NON REFUNDABLE. Payment options. Option 1: Cash Payment - due @ first day of camp Option 2 : Credit/Debit card payment - due @ before the first day of camp. Option 3: Online bank transfer/payment - due @ before the first day of camp. Account details: Account Name: Hoop Dreams London Account number: 83210162 Sortcode: 20-49-81 Ref: campersname_Camp (example: JohnSmithcamp)Please select which age group camper will be enrolled Use the drop down menu to select age group.Ages: 7 - 12 Ages: 13-17 Please select which days camp will be attending camp Monday 23rd October - 10:00 - 15:00 (40 SPACES AVAILABLE)Tuesday 24th October - 10:00 - 15:00 (40 SPACES AVAILABLE)Wednesday 25th October - 10:00 - 15:00 (40 SPACES AVAILABLE)Thursday 26th October - 10:00 - 15:00 (40 SPACES AVAILABLE)Please select the package you would like to enroll player on:1 day camp: £30.002 day camp: £60.003 day camp: £80.00 (3 day discount - save £10.00)4 day camp: £100.00 (4 day discount - save £20.00)Please select payment option:Option 1) Cash paymentOption 2) Debit/Credit payment (please note 1.7% handling fee will be added)Option 3) Online payment Campers attending all 4 camp dates will receive Hoop Dreams London Camp T-shirts. Please select camp T-shirt size (Adult sizes)No camp t-shirt required XS (ages 7-9)S (ages 10-12)M (ages 12-14)L (ages 15-16)**Only applicable for 3 day half-term camps**PLAYER DETAILS: Please enter camper's first namePlease enter camper's last namePlease enter player's addressApt, suite, etc.CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityZip codePlease enter camper's D.O.B(please use the following format - 20/01/2001)EthnicityWhilst it is not compulsory that the following section is completed the footnote at the end of this template explains why it is important.White - BritishWhite - IrishWhite - other Mixed - White & Black CaribbeanMixed - White & AsianMixed - White & Black Africanother mixed backgroundAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - Bangladeshiother Asian backgroundBlack or Black British - CaribbeanBlack or Black British - AfricanBlack or Black British - other black backgroundChinese or other ethnic group - ChineseChinese or other ethnic group - other ethnic group not listedother - not listedMedical informationPlease detail below any important medical information that our coaches/ Junior Coordinator should be aware of (e.g. epilepsy, asthma, diabetes etc.)Does the camper consider himself/herself to have a disability?The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial long-term adverse effect on his or her ability to carry out normal day-to-day activities’.YesNoEMERGENCY CONTACT DETAILS:Please enter parent/guardian mobile numberPlease enter parent/guardian home telephone number.Instructions* Neither the mobile number nor the email should be that of the camper– this could make children vulnerable and is considered poor practice. For a child/young person under the age of 16, the details should be those of the parent/carer. Emergency Contact details - Please enter full name.To be completed by the parent/carer Please enter the information below to indicate the person(s) who should be contacted in event of an incident/accident. Please enter emergency contact numberPlease enter camper's parent/guardian full namefor example: John SmithPlease email parent/guardian email addressPlease select which statement is applicable to parent/carer declarationI agree to my son/daughter/child in my care taking part in the activities of the clubI DO NOT agree to my son/daughter/child in my care taking part in the activities of the clubHoop Dreams London Promo and particapation declarationBy submitting this completed form, I agree to my son/daughter/child in my care taking part in the activities of the Hoop Dreams London Basketball Camps. Additionally by completing this form, I agree to adhere to the code of conduct for parents/carers and my child shall adhere to the code of conduct for Hoop Dreams London Basketball Camps. I understand that I will be kept informed of these activities – for example timing and transport details. I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with that injury/illness appropriately. To comply with the Data Protection Act 1998, we need your permission before taking any images of your child for future advertising and promotion purposes. If you do not wish your child’s photograph to taken or used in any promotional material please tick this boxPlease select one of the following regarding promo declarationI DO give consent for my child's picture/video to be taken and used for Hoop Dreams London promotional purposes on social media sites, flyers, ect.I DO NOT give consent for my child's picture/video to be taken and used for Hoop Dreams London promotional purposes on social media, flyers, ect.Submit