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  It's time for the 2020 - 2021 NCYBL season!  Registration is open to boys and girls that are between the ages of K4-6th grade.   

 

Cost will be $120 for your first child, $100 for a second sibling, and $80 for each additional sibling.  Checks can be made out to Jemison Middle School.. Registration forms can be turned in at the main offices of JES, JIS, JMS, JHS, THS. REGISTRATION FORMS AND MONEY MUST BE TURNED IN BY NOVEMBER 20, 2020.

 

 Practices will begin on 12/7/2020.  Games will begin on 1/10/2021.  Games will be played on Saturdays (and Friday nights if needed)

 

Player Information

 

Player name ______________________________________Grade ________ 

 

Age (As of November 1, 2020) ________________ Gender________


Name of School Player Attends: ________________________

Years of experience playing organized basketball (ex. NCYBL, YMCA, Upward, etc.)  _____________

Parent/Guardian ______________________________________________________________

 

Address _______________________________________City __________________________

 

Phone number ___________________ Email _______________________________________

 

Uniform Information                                                                             

Jersey YS YM YL AS AM AL AXL

Shorts YS YM YL AS AM AL AXL

 

 

 

 

Emergency Contact and Health Information

Emergency contact name and number      __________________________________________

 

___________________________________________________________________________

 

Relationship to player  ________________________________________________________

*****(please see back for additional information)*****

Insurance Information

Name of policy holder _______________________________________________________

 

Insurance company _________________________________________________________

Subscriber ID/Group Number __________________________________________________

 

Card Number/Date __________________________________________________________

 

Does your child have any allergies, chronic illnesses, or medical conditions? ____________

__________________________________________________________________________

Parental Permission for Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorized the person in charge to take my child to:

 

Name of Physician _____________________________________

 

Phone number _________________________________________

 

I give consent for the facility to secure any and all necessary emergency medical care for my child.

 

Release of Liability

Although the safety of all sports activities is the primary concern, indoor sports activities at North Chilton Youth Basketball facilities may cause injury and/or death.  I expressly assume any risk that may arise and agree to waive the right to pursue any claim against NCYBL or its organizers.

 

Signed _______________________________________________  Date _________________

 

 

 

 

 

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