2011 Basketball Registration

Basketball Registration Form
Belvidere Youth Athletic Association (BYAA)
Freshman 3rd/4th grade Junior Varsity 5th/6th grade Seniors 7th/8th grade
OFFICIAL USE ONLY: Registration pd Uniform deposit
NOTE: A $20 fee will be assessed for late registrations. Visit www.byaasports.com for registration dates and locations. $50.00 Uniform deposit check is required. . REGISTRATION FEES: $60.00 1 CHILD $90.00 2 CHILDREN RD TH TH $30.00 ADDITIONAL FOR 3 , 4 , 5 , ETC. Cash
Volunteer:
Head Coach
Assistant Coach
Todays date:
Registration fee total:
Make checks payable to: BYAA

PARTICIPANT INFORMATION
Check number:
Receipt number:
Participants First name:
Last:
Middle:
Birth date: mm/dd/yyyy
Sex: Male Female
Street address
Home phone number:
Secondary phone number:
Town:
NJ
Zip code:
UNIFORM SIZING CHART: YOUTH: Y Small, Y Med, Y Large ADULT: A Small, A Med, A Large, A XLarge Shirt Size Pants Size Height: ft in Weight: lbs
Do you play travel baketball?
PARENT/GUARDIAN INFORMATION Fathers(Guardian) name: Mothers(Guardian) name:
Fathers address (if different from participant)
Mothers address (if different from participant)
Home phone number:
Cell phone number:
Do you use text messaging service:
Home phone number:
Cell phone number:
Do you use text messaging service:
E-Mail:
E-Mail 2:
EMERGENCY AUTHORIZATION Does the participant have a history of illness or allergies? If yes, describe Yes No Name of participants doctor: Doctors phone:
List any regularly taken medication:
In case of emergency, I/We hereby authorize emergency treatment and/or care of the above participant at any hospital. If in an emergency I/We cannot be reached, please contact: Relationship to participant: Phone number: Other phone number:
PARENT OR GUARDIAN AUTHORIZATION, DISCLAIMER, AND WAIVER OF LIABILITY As the parent/legal guardian of (childs name), I give my approval for his/her participation in any and all activities during the current season for the sport indicated above. I assume all risks and hazards incidental to such participation including transportation to and from the activities. I do hereby waive, release, absolve, indemnify and agree to hold harmless the participants in the BYAA program and persons transporting my child to and from activities for any claims arising out of any injury to my child, except to the extent and in the amount covered by the accident-liability insurance carried by the Athletic Association. I also, give my permission for BYAA to take and use any photograph or video/audio recording which my child appears for promotional purposes on the association website. I accept that tryouts may be held when necessary for team selections based on league guidelines. I acknowledge and agree to the BYAA commitment and disciplinary policy posted at WWW.BYAASPORTS.COM and recognizes that participation is subject to the by-laws established by the association. I consent to and attest to all the information on this form. Date: Patient/Guardian signature
2011 Basketball Registration LAST REVISED 10/5/2011
Belvidere Youth Athletic Association Medical Release

NOTE: To be carried by any Regular Season or Tournament Team Manager together with team roster or eligibility affidavit.
Player: __________________________________________ League Name: Belvidere Youth Athletic Association Parent or Guardian Authorization:
Date of Birth: _______________ Sport_______________
In case of emergency, if family physician cannot be reached, I hereby authorize my child to be treated by Certified Medical Personnel (i.e. EMT, First Responder, E.R. Physician, etc). Family Physician: ____________________________________ Phone: ______________________ Address: __________________________________________________________________________ Hospital Preference: _______________________________________________________________ In Case of Emergency Contact: ___________________________________________________________________________________
Name Phone home/cell Relationship to Player
___________________________________________________________________________________
___________________________________________________________________________________
Please list any allergies/medical problems, including those requiring maintenance medications (i.e. diabetic, asthma, seizure disorder):
Medical Diagnosis Medication Dosage Frequency of Dosage
The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.
X______________________________________________
Authorized Parent/Guardian Signature
Date: ______________________
WARNING: Protective equipment cannot prevent all injuries a player might receive while participating in sports. 2011 Basketball Registration LAST REVISED 10/5/2011
2011 Basketball Registration LAST REVISED 10/5/2011

2011 Basketball Registration

Uploaded by

Copyright:

Available Formats

2011 Basketball Registration

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2011 Basketball Registration

Uploaded by

Copyright:

Available Formats

Basketball Registration Form

Belvidere Youth Athletic Association (BYAA)

OFFICIAL USE ONLY: Registration pd Uniform deposit

Registration fee total:

Make checks payable to: BYAA

Participants First name:

Birth date: mm/dd/yyyy

Sex: Male Female

Home phone number:

Secondary phone number:

Do you play travel baketball?

PARENT/GUARDIAN INFORMATION Fathers(Guardian) name: Mothers(Guardian) name:

Fathers address (if different from participant)

Mothers address (if different from participant)

Home phone number:

Cell phone number:

Do you use text messaging service:

Home phone number:

Cell phone number:

Do you use text messaging service:

List any regularly taken medication:

2011 Basketball Registration LAST REVISED 10/5/2011

Belvidere Youth Athletic Association Medical Release

Date of Birth: _______________ Sport_______________

2011 Basketball Registration LAST REVISED 10/5/2011

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Date of Birth: _ Sport_