Reuter Family YMCA Youth Basketball League

Winter 2012 Registration Form

Registration:
League Information:
Dates: October 1-December 30
Lil Shots: 3-4 Years old
Registration Fee: $70 Member; $90 Non- Member
Rookies:
*Financial Assistance Available*
Division 1: 5-6 years old
League Dates:
Division 2: 7-8 years old
First Week of Practice: January 9
Shooters: 9-10 years old
Season: January 21-March 10
Practices and Games will be held at the Reuter YMCA Gymnasium
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Reuter Family YMCA Basketball Registration Form

Return this form with payment to Reuter Family YMCA Member Services by December 30th

_____________________________________________________________________________________________________________________
Players Name
Birth Date
Age & Division
Sex
_____________________________________________________________________________________________________________________
Childs School
Number of seasons played basketball
_____________________________________________________________________________________________________________________
Mailing Address
City
State
Zip
_____________________________________________________________________________________________________________________
Parent Contact
Phone
E-mail (Required)
Please list one car pool buddy: ______________________________________
Volunteers Needed! Please circle one
Head Coach
Assistant Coach
Referee

Please Circle Preference for Practice

Monday
Thursday

Tuesday
ANY

Jersey Size
Youth
XS S M L

Adult
S M L

I hereby, for myself, my heirs, executors, and administrators, waive and release any and all claims and damages I may have against the
YMCA of Western North Carolina and their respective agents, representatives, successor, and assigns, for any and all injuries which may
be suffered by me or my family. I agree to comply with YMCA policies and procedures and understand that my participation can be
terminated without refund for exhibiting inappropriate behavior or abuse toward the YMCA staff and/or facilities.

Please list any medical conditions:

Signature

Todays Date