Youth Basketball League Registration Form

Wyoming Valley Youth Basketball League 2021- Registration Form

wvyb570@gmail.com

Athlete Information

Player Name

First NameLast Name

GRADE

SEASON 1 RETURNING PLAYER?

TEAM # DID YOU PLAY FOR? blanks TEAM COLOR? blank

SHIRT SIZE

Basketball skill level

Guardian / Parents Names

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

PHONE 1

Area CodePhone Number

PHONE 2

Area CodePhone Number

E-mail

Interested in Volunteering ?

WOULD YOU LIKE TO BE A GAME SPONSOR

I would like to play on the same team with following players. League organizers will form teams base on this buddy list and your skill level.

Second Contact & Health Insurance Information

Second Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

PAYMENT OPTIONS

Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?

Please describe

Confirmation E-mail

EACH PLAYER REGISTERED WILL RECEIVE A SAFETY WAIVER AFTER COMPLETED REGISTRATION AND FULL PAYMENT. WE WILL NEVER TURN AWAY A PLAYER DUE TO FINANCIAL ISSUES; BUT NO PLAYERS WILL BE ABLE TO PLAY IN FIRST GAME UNLESS REGISTERED FOR INSURANCE REASONS. PLEASE MAKE A PAYMENT ARRANGEMENT WITH THE DIRECTOR OR APPLY FOR A PLAYER SCHOLARSHIP...

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at WVYB570@GMAIL.COM.

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