Registration Form

Date: __________________________________________________________
Parent Name: _________________________________________________
Participant Name: _______________________________________ School:
_______________________________
D.O.B: _________________________________
________________________

Age: ________ Current Grade Level:

Address: _____________________________________________________
Contact Number: ___________________________________ Email Address:
________________________________
check all that apply
Adult League Volleyball
Fitness
CYL Volleyball
Adult League Dodge ball
CYL Basketball
Adult League Basketball
Battle
CYL Indoor Soccer
Friday Night Shoot Around
SST/Agility/Strength

Group
YoBody
Body

Do you currently play club volleyball? ___________ Name of Club:

_____________________________
Columbus Youth League - 1st 4th $55 plus $10 shirt (1 day per week)
________________________
5th 8th $65 plus $10 shirt (2 days per week)
_______________________
Adult Training:
3 sessions per week/monthly
SST/Agility/Strength : 2 sessions per week/monthly
Kids Health:
2 sessions per week/monthly
Payment Type: cash

credit

check

Check all health conditions that apply:

asthma
diabetes
seizures allergies

other:
______________________________________________________________________________
___________________
Does your child have any medical issues? _____ (list issues)
______________________________________
Does your child have any current/past injuries? ______ (list injuries)
____________________________
Does your child take medication? _______ (list meds)
______________________________________________
CSTC Team Member Signature: _________________________________________
Parent/Guardian Signature: _____________________________________
WAIVER FORM: