Elks Lodge #645 Hoop Shoot Pre-registration

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Event Date: December 4, 2021

*Formal registration will take place the day of the event. You MUST bring a copy of your child's birth certificate.

Registration Times:
Ages 8-9: 8:30 AM
Ages 10-11: 10:00 AM
Ages 12-13: 11:15 AM

Event Address: A.S.K elementary School, 10 Route 209, Port Jervis, NY 12771

Contact: Caitlyn Gunderman at elks645hoopshoot@gmail.com

Child's Name (First and Last) *

Child's Birthdate *

YYYY

How old will your child be on April 1, 2022? This age dictates their division. *Child must be 8 years of age and no older than 13 years of age on April 1, 2022. *

8-9

10-11

12-13

Child's Gender *

male

female

Parent Email *

Parent's Phone Number *

Home Address *

I understand that I must bring my child's birth certificate. *

Yes

Required

I understand that I will have to complete the day of registration form. *

Yes

Required

I understand that I must arrive on time otherwise my child will not be permitted to participate. *

Yes

Required

I understand that Covid protocols will be followed the day of the event. *

Yes

Required

I understand that my child will need to wear a mask while inside the facility. *

Yes

Required

I understand that my child should be properly dressed for the event (sneakers & gym attire), bring a bottle of water, and any medications (ie. inhaler, epi-pen) if needed. *

Yes

Required

All participants are invited to the Port Jervis Youth Center (located next to the library at 134 Pike Street) at 4:00 PM for a pizza party. Will your child attend? *

Yes

Required

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