BELLE VERNON AREA YOUTH BASKETBALL

BELLE VERNON AREA YOUTH BASKETBALL
RECREATION BASKETBALL PROGRAM – SPONSORED BY THE WASHINGTON TOWNSHIP YOUTH ASSOCIATION
REGISTRATION FORM
2014—2015
PLAYER’S NAME ___________________________________________________
ADDRESS________________________________________________________
_______________________________________________________________
PHONE ________________________CELL NO._________________________
PARENT/GUARDIAN NAME_____________________________________________________
DATE OF BIRTH_________________________________CURRENT GRADE________________
E-MAIL ADDRESS_____________________________________________________________
IF YOU ARE INTERESTED IN HELPING - CHECK HERE HEAD COACH
PLAYER SHIRT SIZE – PLEASE CIRCLE ONE
ADULT SMALL
ADULT MEDIUM
YOUTH MEDIUM
ADULT LARGE
ASST. COACH
YOUTH LARGE
ADULT X-LARGE
----------------------------------------------------------------------------------------------------------------------------I (PARENT NAME)_____________________________________GIVE MY PERMISSION FOR MY CHILD
(PLAYER NAME)___________________________________TO PARTICIPATE IN THE BVA YOUTH BASKETBALL PROGRAM. MY CHILD RESIDES IN THE BELLE VERNON AREA SCHOOL DISTRICT, AND I AGREE
TO PAY THE REQUIRED REGISTRATION FEE OF $40.00. I WILL COMPLY WITH ALL RULES, REGULATIONS,
AND BY LAWS ACCORDING TO THE WASHINGTON TOWNSHIP YOUTH ASSOCIATION. I WILL FOLLOW
THE W.T.Y.A. PARENT CODE OF CONDUCT. I AGREE TO FORFEIT MY FEE IF I DO NOT COMPLY.
PARENT/GUARDIAN SIGNATURE______________________________________
DO NOT WRITE BELOW THIS LINE – OFFICIAL USE ONLY
TOTAL AMOUNT PAID CASH___________________OR CHECK NUMBER_______________
SPECIAL REQUEST__________________________________________________________
_________________________________________________________________________