Cys Sports Registration Form printable pdf download

CYS SPORTS REGISTRATION FORM

Sponsor Name: ____________________________________ Rank: _______

___MIL ___CIV ___CONT

(Parent)

Employer/Unit: ____________________________________ Work Phone: __________________________

Email: ___________________________________________ Cell Phone:

Spouse Name: ____________________________________

Rank: _______ ___MIL ___CIV ___CONT

Employer/Unit: ____________________________________ Work Phone: __________________________

Email: ___________________________________________ Cell Phone:

Emergency Contact/Release Designee __________________________________ Phone: _____________________

Fee: $_______

Ck#______

Cash

Coaches Discount

Participant’s Name ____________________________________

Program ________________________

Address: _________________________________________________________________________________

street

city

state

zip

Home Phone: ___________________________ School Grade:

Last Sports Physical _____________

Child’s Age: ________

Date of Birth: _____________

Ethnicity ________________________

Any physical conditions or allergies? ___________________________________________________________

REFUND POLICY: No refunds unless program is canceled, participant moves out of state, or serious

injury prevents participation, prior to start-up date.

WAIVER: I (parent/guardian) understand that in taking part in this program/activity, there is a risk of

injury, that participant/my child is assuming the risk of such injury by participating; and my child will not

be covered by any program insurance and agree to hold harmless the team, program, coach, instructor,

CYS, or Department of Army for injuries received while participating in the above-noted program.

PARENT/PARTICIPANT ACKNOWLEDGES AND AGREES TO THE FOLLOWING:

1. To respect the team’s coach and abide by his/her decisions for the team. To not coach the game from the

sidelines nor subvert his/her authority in any way, and direct all issues or complaints to the age group commissioner

or program chairman.

2. To strictly adhere to the NYSCA Code of Conduct and all rules governing use of government facilities. Refrain

from offensive comments to players, coaches, or officials. Spectators exhibiting disruptive behavior, or violating the

Code of Conduct or rules will be required to leave the grounds immediately!

3. To permit the use if participant’s likeness (e.g. photos) and/or name in advertisements, press release and literature

and/ or posted on the website for the above program.

4. To return all rented or borrowed equipment when notified to do so, the failure of which will result in forfeiture of

participation in future CYS programs.

5. Give consent for an authorized CYS representative to take my child/children for care, medical or dental, in an

emergency situation where the child’s condition represents a serious or imminent to his/her life, health or well-

being. I understand that conscious effort will be made to notify me prior to such action and the expense, if any, will

be borne by me. Treatment at an Army medical facility may be provided without additional consent under provision

of AR-40-3, paragraph 2-24b.

6. A current medical statement will be provided prior to the first practice or the child/youth will not participate in

practice or games until it is provided. They are still on the team, can attend meetings, receive uniforms and observe

the practice/games. If you have a sports physical on file is must be renewed by the time of expiration.

Signature: ______________________________________

Date: _______________

Parent/guardian

Cys Sports Registration Form

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