St. Catharines CYO Basketball Registration Form 2012/2013

Please make cheques payable to: ST CATHARINES CYO REBELS BASKETBALL
c/o Robert Miller; 25 Edgedale Road; St Catharines, On; L2R 3V9


___New Player ___Returning Player ___Select Team Tryout ___House League


PLAYERS
Name:_______________________________________ Sex: M F
Address:___________________________________________________
City:______________________________ Postal Code:______________
Phone:_______________
Parent/Guardian e-mail address________________________________
Player e-mail address: _______________________________________
Date of Birth: Month____ Day____ Year____
Height:____feet ____inches Weight:____ lbs
as of Sept: School:________________________________ Grade:____
Health Card #:____________________
Medical Conditions we should know about:_______________________
__________________________________________________________


PARENTS/GUARDIANS
Name(s): __________________________________________________
Address: Same as above ___ or _______________________________
City: _______________________________ Postal Code: ____________
Home Phone: __________________ Cell Phone: __________________


NOTICE OF WARNING
There is a potential risk for injury involved in training and participating in any sport. The St Catharines CYO Rebels have tried to create a safe and controlled environment for safe participation. The St Catharines CYO Rebels and Basketball Ontario have established rules for participation and conduct on or about the area that should be followed.
I agree to abide by the Published Rules of Basketball Ontario's Fair Play Policy and the St Catharines CYO Rebels Basketball Organization.

Parents Signature: ___________________________________________


VOLUNTEER
Name(s): ___________________________________________________
Home Phone: __________________ Cell Phone: ___________________

____Coach ____ Assistant Coach ____Convenor ____Referee




OFFICE USE ONLY: ____Cash ____Cheque ____MO
Payment Date:____________ Amount:____________
Siblings: ____Yes ____ No Division: ____________