2015 Junior Grizzlies Basketball Registration

2015 JUNIOR GRIZZLIES BASKETBALL REGISTRATION

Player’s Name ___________________________________________________ DOB ____________ Age _________ M __ F __

(Age as of 12/21/2014)

Age Division (Please Circle)

6-7

8-9

10-12

Player’s Experience:

Beginner _____________ Intermediate _____________ Advanced _____________

# of Years Playing________________________ Height _____________________ Weight _______________________

Jersey Size

AXL

Email (Majority of Communication is By Email) __________________________________________________________

Address___________________________________________________City__________________State_______ Zip______________

Parent/Guardian _______________________________________________________________________________________________

Primary Phone # _______________________________________ Secondary Phone # ______________________________

Emergency Contact__________________________________________________Phone___________________________________

School Attending_______________________________________________________________________Grade_________________

Any Medical Concerns_________________________________________________________________________________________

Special Requests (REQUESTS ARE NOT GUARENTEED) ________________________________________________

_____________________________________________________________________________________________________________________

COACHES NEEDED! PLEASE FILL OUT IF YOU ARE WILLING TO COACH THIS SEASON

Name ___________________________________________________ Head Coach __________Assistant Coach __________

Phone # ________________________________________________ Email __________________________________________________

MANDATORY COACHES MEETING WILL BE DECEMBER 29

at 6PM @ THE Davis YMCA

I, the above referenced youth athlete’s parent/guardian, hereby register my child to participate in YMCA youth athletics for the above listed sport. I

acknowledge and understand that there is a risk of injury involved in athletic participation I understand that my child will be under the supervision and

direction of Y staff and volunteer coaches. However, I acknowledge and understand that the YMCA cannot eliminate the risk of injury in sports. Injuries

may and do occur. I freely, knowingly, and willfully accept and assume the risk of injury that might occur from my child’s participation in youth athletics. I

hereby release the YMCA of Memphis and the Mid-south its staff and volunteers from accident and liability obligation. I, the undersigned, hereby certify that

to the best of my knowledge, my child is physically able to safely participate in the sports activity for which he or she has been registered I understand that

the goals and objectives of the Y Youth Sports Programs are based on fun, fair play and skill development. Photographs will occasionally be taken of the

players during the sports activities. By signing this registration form, I consent to the use of pictures of my child for displays, brochures, and promotional

materials with no compensation to me or my child.

Parent’s Signature _____________________________________________________________________________ Date________________________________

THE SPORTS DIRECTOR WILL CONTACT YOU BY EMAIL WITH FOLLOW UP INFORMATION