candlewood ms basketball

CW Middle School Basketball Registration Form (1)

Youth's Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Date of Birth*
School*
Race/Ethnicity
Grade*
Allergies or Special Needs:*
Parent or Guardian Name*
First Last
Parent or Guardian Cell Phone*
Email*
Consent*
I hereby give my permission for my child to attend the REACH CYA Basketball Program.
I understand:
The program will be cancelled when school is not in session
 The program will be supervised by REACH CYA staff and volunteers.
 The program ends at 8:00 pm. Prompt pick-up is mandatory.
 REACH CYA does not provide any health/hospitalization insurance for my child.
In the event you cannot be reached in a medical emergency, you give REACH CYA staff authorization to secure proper
medical treatment, including taking your above named child to the nearest hospital.
 You release REACH CYA staff, Board of Directors, volunteer chaperones, designated drivers and all funding sources from any liability or legal
action.