REGISTRATION BEGINS NOW THROUGH DECEMBER 13 Practices and Games will be played at the YMCA

MONROEVILLE AREA YMCA Youth Basketball Boys & Girls Age 3 to 14

Tiny Dribblers (3&4)
Practices Begins 12/19

FEES:
$45 Members $60 Program Participant
Late Registration $10.00 After 12/13 For More Information Contact: Justin Marshall Program Director 251.575.9622
]ustin_ymca@frontier.com

5 & 6 Division
Practice Begins 12/1 9

7 & 8 Division
Evaluations

12/1 9

@ 5: 15 p.m. Practice Begins 12/23

9-11 Division
Evaluations @ 6: 15 p.m. Practice Begins 12/23

12-14 Division
Evaluations @ 7:00 p.m. Practice Begins 12/23

FOR YOUTH DEVELOPMENT FOR HEALTHY LIVING FOR SOCIAL RESPONSIBILITY

We build strong kids, strong families, strong communities

REGISTRATION: NOW - DECEMBER 13 PRACTICES AND GAMES WILL BE PLAYED AT THE YMCA. For Children Ages 3-14 Cost: $45.00 members; $60.00 non-members Sibling discount $5.00; Late Registration Fee $10.00 Player's Last Name Address
Birthdate __ /__ /__ Age

First Name (goes by) City

0 Male 0 Female

Phone Zip

_ _

o
Name of Parents/Guardians: Mother Father Other Emergency Contact Cell # Cell #

Member 0 Non-Member _ Work # Work # Home # Email Email Work # Cell # _

_

Ages: 03-405-6 Shirt Size

(circle one):

07-8

09-11012-14

0 YS 0 YM 0 YL 0 AS 0 AM 0 AL 0 AXL

All games will be played at the YMCA.

I certify that this child is in normal health and capable of participating in the YMCA youth athletics. I do acknowledge the risk of injury is possible. I grant permission for my child to play and in doing so I hereby release any and all rights and claims for injuries and damages I may have against the YMCA their Board, Managers, Employees, Officials, Volunteers and Coaches. If medical attention is required, I give my permission for such medical care when either I or the emergency contact person cannot be notified. I understand that the YMCA does not carry accident insurance on league participants. I agree that the YMCA may photo or videotape my child and use it for their promotion. Parents are responsible for providing transportation for their child to and from practice sessions and games. Name of insurance company _ Insurance policy number _ If your child has any Allergies, Asthmatic conditions, or any hindrances that may affect your child's ability that the Branch should be aware of please list. IN WITNESS WHEREOF, I have executed this Registration, Waiver/Release and Medical Certification form with full knowledge of its contents on this the day of (month) (year).

ParenVGuardian Signature

Print ParenVGuardian Name

VOLUNTEERS NEEDED!!!
We hope you are willing to volunteer in support of this sport program. Please check one (1) or more of the following areas to participate in: Coach 0 Assistant Coach 0 Referee/Umpire

FOR OFFICE USE ONLY: Date Registered Amt. Paid $ Registered By _ _