10/06/2020
Youth Basketball application forms have been sent home with Caldwell 3rd - 6th grade boys and girls. Deadline is October 9th. Please return to the school or Mail them to address on the form. We are looking forward to another great season. Go Little Redskins!!
CALDWELL YOUTH SPORTS
2020 Youth League Basketball Application
Participants Name_________________________________________________________________________________________________________________
(Last) (First) (Middle)
Parent/Guardian__________________________________________________________________________________________________
Address________________________________________________________________________________________________________________________________________________________
City_____________________________________________________________ State____________________________ Zip___________________________
Home Phone (_________)_________________________ Work Phone (__________)__________________________ Cell Phone(__________)_____________________________
Birth Date ________/_________/_________
Would you be willing to Coach or be an Assistant Coach Yes______ No______
Emergency Contact Information
Name ________________________________________________________Home Phone (_________)_________________________Work/Cell Phone (_________)______________________
Please list any allergies, medical conditions or disabilities we should be aware of (confidential to board members and coaches only) ________________________________________________________________________________________________________________________________________________________________
Uniform Information
Dri Fit T-shirt size ( circle one) YS YM YL YXL AS AM AL AXL
Fee to participate is $35.00
Families with multiple children fee will drop $5 per child (example: 1st child $35, 2nd child $30, 3rd child $25)
Open to those entering grades 3-6
Select Team
3rd Grade Boy____ 4th Grade Boy____ 5th Grade Boy____ 6th Grade Boy____
3rd Grade Girl _____ 4th Grade Girl _____ 5th Grade Girl ______ 6th Grade Girl ______
Mail Form and Payment to:
Noble County Recreation
PO Box 124
Caldwell, OH 43724
Questions ??? Contact David 740-885-9467
Deadline for applications October 9th 2020
Leagues will be Cambridge for girls and Either Cambridge or Lowell/Beverly for boys
Consent for Medical Treatment (minor): As the parent or legal guardian of the above named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent. I agree to be responsible financially for the reasonable cost of such assistance and/or treatment.
Waiver: I, the parent/guardian of the registrant a minor, agree that I and the registrant will abide by the rules of the CYS, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with basketball and in consideration for the CYS accepting the registrant for its basketball program and activities. I hereby release, discharge and/or otherwise indemnify the CYS registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.
Photo Release: I hereby grant authorization to the CYS and it’s photographer to use photographs of myself, my child or the program participant(s) for publicity purposes, and/or for resale on its website.
Signature of Parent or Guardian ___________________________________________ Date ______/______/______
