REGISTRATION FOR OUR 2018/2019 ELITE WINTER SEASON

PLAYER INFORMATION
PARENT/GUARDIAN


MEDICAL/EMERGENCY CONTACT INFORMATION

WAIVER INFORMATION
CONSENT FOR MEDICAL TREATMENT FOR A MINOR
As a parent or legal gaurdian of the above named player. I do hereby give my consent for emergency medical care prescribed by a duly licensed doctor of medicine or dentisty. This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of my dependant.

PARTICIPATION CONSENT
I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of THE CENTRAL VALLEY YOUTH BASKETBALL ACADEMY. Recognizing the possibility of physical injury associated with various athletic programs, I hereby release, discharge, and/or other wise indemnify "THE CENTRAL VALLEY YOUTH BASKETBALL ACADEMY", (its directors, volunteers, affiliated organizations and facilities utilized for the programs), against any claim by or on my behalf of the registrant as a result of the registrant's participation in the program and/or being transported to or from the same, which I hereby authorize. I understand there is NO REFUNDS.

PHOTO/VIDEO/AUDIO CONSENT AND WAIVER
From time to time photographs, videos, and/or audio clips may be taken of youth and adults engaging in CENTRAL VALLEY YOUTH BASKETBALL ACADEMY (hereafter CVYBA) programs and activities. CVYBA request the right to use all photos, videos, and/or audio clips taken of CVYBA youth and adults, programs, and activities. These may be used for promotional brochures, promotions or showcase of programs on our web sites, showcase of activities in local newspapers, and other purposes.

By signing below (providing a check in the box), I confirm that I understand and agree to the above requests and conditions. I agree to give up my rights with regards to photos, videos, and/or audio clips of me and/or my child(ren) and any claims for payment/royalties. I sign this form freely and without inducement. I confirm by checking the box below that I am of legal age (at least 18 years old) and parent/guardian responsible of the player above.

**DISCLOSURE:

You must pay in full if signing up online. You are responsible to pick up the mandatory fundraiser tickets on the designated dates listed on the website. You are responsible to sell all tickets as part of your registration if wanting to recover a portion of your registration fee paid online (up to $200).

Please note that payment may appear on your statement as paid to "Maxine Estrada" (if a charge back is initiated, an additional fee will be required from you to cover any additional costs).

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Note: Credit Card information can be entered once this form is submitted

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