Philly Youth Sports Academy (Small Fry)

Subscribe to our Newsletter

Registration PYSA- FALL 2019

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

* Birthdate:

* Email:

Gender:

* Grade:

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

I am aware that participation in the PYSA basketball program has some inherent risks and injury can occur. I hereby authorize the directors of the Philly Youth Sports Academy (PYSA) to act for me according to their best judgement in any emergency requiring medical attention to my son/daughter. I waive and release the PYSA, its coaches and volunteers from any and all claims for personal injury. I will be responsible for any medical or other charges in connection with his/her involvement in the program. I hereby expressly permit said minor child to travel by private automobile to activities and events related to the basketball program. I hereby give consent to allow photographs of said minor. I understand pictures may be used by PYSA and Small Fry. I attest I am eighteen years of age or older and that my child is physically fit and have no known medical conditions which prohibit participation in this sport. I have read this waiver and agree to the contents.

I/we agree with the above *

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

OUR SERVICES

LOCAL SPORTS

ELITE

Registration PYSA- FALL 2019