MENU => WelcomeAbout HOACamps / Enrollment Boys BasketballBoys Basketball ApplicationGirls BasketballGirls Basketball ApplicationTeam Discounts Team DiscountsContact UsFAQsFuture CampsFacebook Building Skills since 1971 ~ Fun and Fundamentals ~ Ages 8 to 18 Boys Basketball Application Payment is made securely through PayPal. You can “Save and Continue Later”. 1Camper2Medical3Insurance4Parent/Guardian5Authorization Camper* Full-Time Part-Time I Will Attend - KWU, Salina KS* July 13-16, 2025 Credit Card Payment - PayPal*A $100.00 deposit is required or pay full amount. You do not have to have a PayPal account!Select One:Deposit - $100Full-Time Camper - $425Day-Time Camper - $250Camper Name* First Last Camper Email* Parents Name* First Last Parents Email* Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Height*Age*T-Shirt Size (Adult)* Small Medium Large Extra-Large Date of Birth* MM slash DD slash YYYY What grade will the camper be in next year?*What school will the camper be attending next year?*Roommate Preference (if any)? Include Age.No guarantee of roommates after July 18. AllergiesRecent Illness(es)Chronic Health ProblemsRoutine MedicationPhysician Name & Telephone*Date of Last Tetanus Shot Camper will be covereed by my personal or family accident and illness insurance.* Yes Insurance Company Is?*Group Number*Policy Number*Insurance Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Benefits/Pre-Cert Phone Number Parent/Guardian Name First Last Parent/Guardian Address* Same as camper home address. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian Email Address* Home Phone*Cell PhoneAlternate PhoneInsurance Card UploadYou can attach a copy of both sides of the insurance card OR bring day of registration OR email copy to hoasportscamps@yahoo.com. Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 2 MB. Authorization*WE, the undersigned parents or guardians of the above camper, a minor, do hereby authorize the director of the Heart of America Sports Camps or his designee to select hospital facilities and/or physician of his choice and authorize treatment of the above named camper on an emergency basis in the event such treatment becomes necessary as a result of the participation in the Heart of America Sports Camps. We hereby grant permission for him to participate in the Basketball Camp and acknowledge the fact that he is physically able to participate in camp activities. I will be responsible for all medical bills incurred as a result of illness or accidents for which medical treatment is necessary while the above applicant is at camp, except those bills covered by insurance. Please make sure all information is complete. Authorized