Boy
Girl
(√ Gender)
Age:
(As of 8/31)
Late Registration Form
~ Souderton-Harleysville Youth Basketball Association ~
~ SHYBA ~
Child’s
Name
Phone
Reset Form
Primary:
Last:
First:
MI:
~Optional~
Txt Msg # 1 | Carrier:
Age:
Date of Birth:
Grade:
Weight (lbs):
Height (ins):
Address:
City, State:
Zip:
Experience (yrs):
Organization:
Txt Msg # 2 | Carrier:
Father’s Name
Last, First:
Mother’s Name
Last, First:
Email(s):
Separated by
;
SHYBA’s success depends on the dedicated support of its parents and volunteers. Please
check the appropriate blocks below to help during the upcoming season.
Referee (7-8 year old leagues)
Head Coach
Assistant Coach
Sponsor my child’s team, as available
The Souderton-Harleysville Youth Basketball Association (SHYBA) will not be held responsible for injuries.
I acknowledge that I have been informed that accidents and/or injuries can result from and during activities sponsored by SHYBA including,
but not limited to, the playing of basketball for practice and/or competition. Such activities could include, but are not necessarily limited to
physical training, exercise, running, and hard courts in our area schools.
I accept that SHYBA strives to provide competent adult leadership, guidelines, and makes every effort to conduct its activities in a safe and
proper manner, but I also recognize that injuries can occur despite the most careful and reasonable leadership and supervision.
In consideration of my desire and intention to have the minor listed on the sign up form participate in the activities of SHYBA, I hereby release
and hold harmless SHYBA, its directors, members, coaches, referees, agents and assigns, from any and all causes of action and claims for
injury or damage arising out of my, or the minor listed participation.
I have been informed by the membership of SHYBA that the League maintains and has in effect certain commercial liability insurance. I
further understand that this insurance is for the protection of the SHYBA from law suits and is not designed, nor intended to provide medical,
health, accident nor disability income protection for the minor listed on the sign up form, nor any of the other members.
I have made certain that the listed minor is covered under an effective health insurance and/or accident policy.
BY MY SIGNATURE I AGREE AND ATTEST TO THE ABOVE
__________________________________________
Parent or Legal Guardian
(√) SHYBA use only:
CASH
CHECK # ________
Leagues with other siblings
__________________________
Reviewed Birth Certificate
_________________
Date
Registration Fees $
Fundraiser Purchases $
+$25 Late Fee
Total Cost $ 25.00
Funds received by
SHYBA does not use or disclose to any third party, other than to render the services you requested, any
personally identifiable information about you for any purpose without your expressed prior consent.
(initial)