2016-2017 YM-YWHA WOLVES
COMMITMENT / CONSENT FORM
Dear Players/Parents,
Welcome to the YM-YWHA Wolves Basketball Association. All teams will be based out of the
YM-YWHA and will practice two to four times a week. Attendance is mandatory at all team
events, whether basketball related or not. The season runs from September 2016 to March 2017;
it is a full season commitment - and the entire team counts on each team member to be fully
committed. All expectations and responsibilities are covered in the attached code of conduct.
Players will also be expected to participate in all fundraisers to offset the cost of the gear and
tournaments.
LEAGUE REGISTRATION
All players must include a copy of their Medicare card as proof of age. Without
this information players cannot be added to the active roster. Please attach the
photocopy to the back of the registration package.
PLAYER RELEASE
As per MBL (Montreal Basketball League) and LMMB (Girls League) rules, a
player cannot transfer from one organization to another within the same league
without a written release form from his/her current organization. A player wishing
to change to another organization must request a release form from the
coordinator before April 30th of the current season. The request is not automatic
and is evaluated on a case-by-case basis. Releases after the deadline may not be
granted.
WAIVER
Parent and/or guardian agrees to hold harmless the YM-YWHA, including all
officers, agents, assigns, employees, representatives, volunteers, independent
contractors, or other affiliated agencies from any and all claims or liability for
injuries, damages or death resulting from participation in this program,
notwithstanding that same may have been caused by any action or inaction,
commission or omission, including, but not limited to the negligence of any of the
aforesaid or otherwise.
MEDICAL TREATMENT
The undersigned parent or guardian certifies that the athlete is healthy and able to
participate in this program at the time of registration. Parent or guardian gives
permission to secure proper medical treatment in case of emergency, where parent
or guardian cannot be reached.
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I have read the above statement, accept all terms & completed this form to the
best of my ability.
RAMQ # :_________________________________
Important Medical Consideration:
__________________________________________________________________
__________________________________________________________________
Allergies:
__________________________________________________________________
Signature of Parent or Guardian: ___________________________Date: _______
Signature of Athlete: _____________________________________Date: ______
Athlete Information:
Athlete’s Name:
___________________________________________________________
Date of Birth (YY/MM/DD): _________________________
School: ________________ Grade: _________
Home Address: __________________________________ City: ______________
Postal Code: _______________ Home Phone: ______________________
Cell Phone: ________________ Email address: _________________________
Parent or Guardian:
Name: ___________________________ Relationship: _____________________
Home Phone: __________________ Cell Phone__________________________
Work Phone: __________________ Email Address:______________________
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UNIFORMS
All players are required to sign for the uniform. All uniforms must be returned by
the end of the season. In the event that not all 4 pieces are returned, parents will
receive an invoice for $160. Please initial______
FEES
The fee to play on the YM-YWHA Wolves is $360 for players under the age of
15; and $410 for players over the age of 15 as of registration date. All players
will receive an YM-YWHA membership valid September 1, 2016-August 31st,
2017. (YM-YWHA members must adhere to the Member’s Code of Conduct.).
Our fees cover the cost of league fees, one tournament and the YM-YWHA
membership. Players will also be expected to participate in all fundraisers to
offset the cost of the gear, study hall, uniform, equipment and tournaments.
All payments are made out to YM-YWHA. Payment may be made by Visa or
MasterCard, cash or personal cheque. Please contact Martisha Richards-Thomas
or Adi Shemi directly at (514) 737-6551 ext. 271 or at [email protected].
Payment information:
Credit Card
VISA
MASTERCARD
Name (as it appears on the card)
_________________________________________________
Credit Card #: _____________________________________
Exp: ________
Signature of Parent or Guardian: ___________________________Date: _______
PRE-AUTHORIZED PAYMENT:
I authorize the YM-YWHA to debit my bank account / credit card for the
registration fees.
Please specify amounts should you require a payment plan:
Amount
Date (yyyy-mm-dd)
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REFUNDS
The program fees are bound by the refund policy outlined on the back of your
receipt. A 50% refund is available within 2 weeks of the parents meeting
September 27th, 2016. Note that due to the league registration limitations,
refunds are not possible after November 1st.
BANK or CREDIT CARD REFUSAL:
Any returned payments, (NSF, stopped payment, account closed, declined
payment, etc.) will be subject to a $15 administrative fee.
SPONSOR A WOLVES PLAYER
Parents wishing to sponsor a Wolves player can do so by selecting the box below.
Donor will receive a tax receipt for the full value of their donation.
I would like to sponsor a player for the full $360
I would like to sponsor a Wolves player for $_____
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