BELLE VERNON AREA YOUTH BASKETBALL RECREATION BASKETBALL PROGRAM – SPONSORED BY THE WASHINGTON TOWNSHIP YOUTH ASSOCIATION REGISTRATION FORM 2014—2015 PLAYER’S NAME ___________________________________________________ ADDRESS________________________________________________________ _______________________________________________________________ PHONE ________________________CELL NO._________________________ PARENT/GUARDIAN NAME_____________________________________________________ DATE OF BIRTH_________________________________CURRENT GRADE________________ E-MAIL ADDRESS_____________________________________________________________ IF YOU ARE INTERESTED IN HELPING - CHECK HERE HEAD COACH PLAYER SHIRT SIZE – PLEASE CIRCLE ONE ADULT SMALL ADULT MEDIUM YOUTH MEDIUM ADULT LARGE ASST. COACH YOUTH LARGE ADULT X-LARGE ----------------------------------------------------------------------------------------------------------------------------I (PARENT NAME)_____________________________________GIVE MY PERMISSION FOR MY CHILD (PLAYER NAME)___________________________________TO PARTICIPATE IN THE BVA YOUTH BASKETBALL PROGRAM. MY CHILD RESIDES IN THE BELLE VERNON AREA SCHOOL DISTRICT, AND I AGREE TO PAY THE REQUIRED REGISTRATION FEE OF $40.00. I WILL COMPLY WITH ALL RULES, REGULATIONS, AND BY LAWS ACCORDING TO THE WASHINGTON TOWNSHIP YOUTH ASSOCIATION. I WILL FOLLOW THE W.T.Y.A. PARENT CODE OF CONDUCT. I AGREE TO FORFEIT MY FEE IF I DO NOT COMPLY. PARENT/GUARDIAN SIGNATURE______________________________________ DO NOT WRITE BELOW THIS LINE – OFFICIAL USE ONLY TOTAL AMOUNT PAID CASH___________________OR CHECK NUMBER_______________ SPECIAL REQUEST__________________________________________________________ _________________________________________________________________________