3rd & 4th Grade Boys/Girls Basketball League
2016 - Nov. 12th, Nov. 19th, Dec. 3rd, and Dec. 10th
Games will be held at Anderson, Pineville, Noel, and Southwest City
$10 per Player
First Name:_________________________ Last Name:______________________________ Boy or Girl
Address:__________________________________ City_______________ East or West of Hwy 71?___
Grade:_________.
Shirt Size: YS YM YL YXL AS AM AL AXL.
School Attending: _______________________________________
Parent(s):___________________________________________________________________________
Phone: Mom-____________________ Dad-______________________ Other-____________________
Email: Mom-_________________________________ Dad-___________________________________
Insurance Carrier/Policy #:_____________________________________________________________
Emergency Contact Person:____________________________________________________________
Emergency Contact Phone(s):__________________________________________________________
Relationship to Player:_________________________________________________________________
Does player have any allergies/medical concerns?
Yes
No
If yes, please list:_____________________________________________________________________
In case of emergency I authorize my child to be treated by Certified Emergency personnel: (i.e. EMT,
First responder, ER Physician)
Parent/Guardian Signature: __________________________________________________________________
Volunteers needed! Please let us know how you would like to help:
(circle one)
Head Coach
Asst. Coach
Other____________________________
_________________________________________________________
Register Online: www.MCYBA.com or www.fb.com/mcybasketball
Register by mail: MCYBA, PO Box 171, Anderson, MO 64831.
Contact Ashlie Martin at 417-846-7318 or Chris Smith at 417-379-8523
~ McDonald County Youth Basketball Association, Inc. is a Non-For-Profit Organization ~