Riverside Youth Basketball Association

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2016-1017 RYBA Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

Home Phone:

* Birthdate:

Email:

Gender:

* Grade:

* Shirt Size:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

My Child has my permission to participate in this youth sporting event sponsored by RYBA Basketball league.

In consideration of the acceptance of my application for the entry into the above, I hereby waive, release and discharge any and all claims for damages for death, personal injury or property damage which I may have, or which hereafter occur to my child, against the RYBA, as a result of my participation in the event. This release is intended to discharge the RYBA, its officers, officials, employees, volunteers, and any other involved municipalities or public agencies from and against any and all liability arising out of or connected in any way with my participation in the event, even though that liability may arise out of the negligence or carelessness on the part of persons or entities mentioned above. I further understand that accidents and injuries can arise out of the event; knowing the risks, nevertheless, I hereby agree to assume the risks and to release and to hold the harmless all of the persons or agencies mentioned above who, through negligence or carelessness, might otherwise be liable to me or my heirs or assigns for damages. It is further more understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. By clicking the submit button below I hereby accept the agreement and waive, release and discharge any and all claims against the RYBA.

I/we agree with the above *

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2016-1017 RYBA Registration Form