Grand River Area Family YMCA (4051 bytes)

1725 Locust Street, Chillicothe, MO 64601

   Phone:  660-646-6677    FAX:  660-646-5668
 
YMCA Logo (4209 bytes)Summer Basketball
Registration Form

Entry Fee: $26 Per Player

Please note! (861 bytes)All fields are required!

 

This online submission is your early reservation.
After completing this form, print the form before you hit the SUBMIT button.
This form must be completed, signed, and turned in before being eligible to participate.
The printed form must be signed and mailed to the YMCA with your check for $26.
Player Name:

Sex:

Male    Female
Birth Date:

Grade in School This Fall:

Street Address:

City:

State:

(Use 2-letter abbreviation)
Zip Code:

Home Phone:

Email:

Team Name:

Team Coach:

T-Shirt Size:

Division:

Name:

Phone:

Relationship:

Signature:  

This form must be completed, signed, and turned in before being eligible to participate.
Please print this form before you hit the SUBMIT button.
The printed form must be signed and mailed to the YMCA with your check for $26.
The online submission is your early reservation.

INSURANCE

It is expressly understood that sponsors of the Grand River Area Family YMCA summer Basketball league do not insure against, nor accept responsibility for, personal injury or property loss or damage to the participant which might be sustained as a result of his/her participation. Parents or legal guardians are responsible for medical care; treatment and insurance for said participant.

RELEASE/WAIVER

In return for allowing the above mentioned athlete to compete in Summer Basketball, the undersigned, intending to be legally bound, release and forever discharge the Grand River Area Family YMCA, Chillicothe R-2 School District, and the North Central Missouri YMCA, their agents, representatives, successors and assigns from any claims for damages, including any claims for loss, damages or injury to athlete's person or property arising out of athlete's performance or failure of performance. If the undersigned has doubts about the physical condition of said athlete; a pre-league physical examination by a licensed physician is recommended. In addition, the undersigned, hereby authorizes any first aid, medical treatment deemed necessary in case of emergency for said participant during competition and give permission for emergency treatment, x-rays, or surgery as recommended by attending physician. I/We assume full financial responsibility for any and all medical care for participant.

Any pictures or videotape of participant during competition may be used for promotional purposes of the YMCA activities and programs.

PARENT/LEGAL GUARDIAN SIGNATURE REQUIRED:

X ______________________________________________________________

You may submit the Team Roster and the Registration Forms via email by using the SUBMIT buttons at the bottom of each form. However, please also print each registration form before you submit it, sign the printed copy, and mail with your check to the Grand River Area Family YMCA, P.O. Box 751, Chillicothe, MO 64601.

Or, you may simply complete the forms, print them, and mail to the address above. In that case, you do not need to press the SUBMIT button above.

Questions? Call Dave Rogers or Kathy Hundley at 660 646 6677.

Coaches Letter  |  League Rules  |   Registration Form  |  Team Roster

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Page updated Wednesday, April 06, 2005

Web Site Design by BK Web Works, Chillicothe, MO 660-646-3094
Web Hosting Service: Green Hills Telephone Corporation, Breckenridge, MO 1-800-846-3426
Site online February 6, 1999