BASKETFORM

CDYB Registration Form

Complete and submit by Nov 15, 2016

Players Name
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Date of Birth / Grade / M or F
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Shirt Size YM, YL, YXL, AS, AM, AXL
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Parent/Gaurdian
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Home #
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Cell #
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Email
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Emergency Contact (if parent cannot be reached)
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Contact info
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Preferred Doctor
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Doctor Contact Info
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Is your child under a doctors care or taking medication?
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Allergies and or Medical Condition?
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Do you have Health Insurance Coverage? Ins Company Name and Policy #
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If the game is canceled due to weather how should we contact you?
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The purpose of having medical info listed is to ensure medical personnel have details of any/all medical issues that may interfere with treatment up to and including transport by ambulance and hospitalization. By completing and submitting this form I give permission for CDYB to have my child treated by Certified Emergency Personnel and release CDYB of all liabilities involved in the treatment of my child Parent / Gaurdian
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Fees for the Season i $30 per child $75 max per family Fees due by November 15,2016 Make checks payable to: CDYB Cairo Durham Youth Basketball
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