Ymca Spring Basketball Registration Form printable pdf download

Spring Basketball Registration Form

PLEASE PRINT CLEARLY ALL INFORMATION

PLAYER INFO

First Name __________________________________ Last Name____________________________

Boy

Girl

Player’s Height: Ft. ___ In. ____

Player’s Street Address ________________________________________________ City _______________________________________ Zip ____________________

School ___________________________________________________ Current Age ________ Grade _______ Date of Birth: __________________

________________________________________________________

ENROLLING PARENT INFO

Last Name _______________________________________________ First Name _________________________________________________ Initial _____

Street Address ____________________________________________________ City ___________________________________________

Zip _______________________

Home Phone: __________________________________ Cell Phone: __________________________________ Work Phone___________________________________

Preferred E-mail Address for League/Team Notices: _________________________________________________________________________________ (print legibly)

OTHER PARENT INFO

Last Name _______________________________________________ First Name _________________________________________________ Initial _____

Street Address ____________________________________________________ City ___________________________________________

Zip _______________________

Home Phone: __________________________________ Cell Phone: __________________________________ Work Phone___________________________________

COST INFO

YMCA REFUND POLICY

100% minus $25 processing fee before the start of the season; 50% after 1

game; No refund after 2nd game; Membership is non-refundable

and non-transferable

Registration Fee:

$160 per player plus Youth Membership

$40 per child or Family Membership- $80 per family

Parental Code of Conduct

I acknowledge that I have received, read and agree to the guidelines and policies included in the YMCA BASKETBALL LEAGUE Program Manual and that as the

responsible parent and/or guardian as well as primary role model for my child/children, I agree to demonstrate in my actions and language the code of conduct and

league standards described in the Program Manual.

I commit to supporting with my child/children the YMCA’s Four Core Values of: Honesty, Respect,

Responsibility and Caring. If I do not consistently demonstrate the conduct becoming to the YMCA BASKETBALL Program Guidelines, I understand that I may be

expelled from the league at any time.

_______________________________________________________________________________________________________________________________________________________________________________________

Parent/Guardian’s Signature

Date

Medical Release Statement

In the event that I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the YMCA staff person present to hospitalize and/or

to provide necessary medical attention for my child as named above. I give permission for my child to engage in supervised activities during the session(s) that I

have registered for above. I also give my permission for the YMCA to use photos, slides, or videotaped material of my child or family for promotional purposes. I

understand that the Triunfo YMCA does not carry primary health or accidental insurance on its members or participants. Expenses incurred in the treatment of

illness or injuries are the responsibility of the participant and his or her insurance carrier.

_______________________________________________________________________________________________________________________________________________________________________________________

Parent/Guardian’s Signature

Date

Volunteerism is encouraged at the YMCA. Mark below to indicate your willingness to serve.

Head Coaching

Assistant Coaching

Referee

Mentors, manuals, clinics, and moral support available.

Screening and Fingerprinting required

*Volunteerism at the YMCA is a privilege, not a right.

Payment Info:

Check

Credit Card