Middle School Basketball Program at Candlewood MS

CW Middle School Basketball Registration Form

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.

Once you hit the submit button, this form should automatically generate a confirmation email to you. If you do not receive a confirmation email, please check your spam/junk folder. Thank you!