Newfields Youth Athletic Association - (Newfields, NH)

2023-24 Grades 3-4 Coed Basketball Registrations

2023-24 Coed Basketball for Grades 3-4

$130 per child

Practice evening TBD at NES - games Saturday morning at NES

Questions: newfieldsathletics@yahoo.com or Jesse Kells 957-0433

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

Gender:

* Grade:

PARENT/GUARDIAN

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Child's Physician:

Allergies/Medications:

WAIVER INFORMATION

I give my permission for my child to participate in the Newfields Youth Athletic Association's (NYAA) program. This may include practices, games, fundraising, and any other league-sponsored events. I acknowledge that there are risks inherent in playing sports, which could cause personal injury to my child. I assume all risks on behalf of my child and release the NYAA, coaches, league representatives, and officials from liability for all such injuries that may occur to my child during practices, games, and travel to and from the events and any other league-sponsored activity.

I acknowledge that as a parent or guardian of the above-mentioned child, I am solely responsible for the safety of my child while going to or coming from any practice, game, or any league-sponsored activity.

I understand that every reasonable effort will be made to contact me in the event of illness or injury while my child is participating in any activities involving the NYAA. However, if I cannot be reached in a timely manner, I authorize my child, coach, or other league representative to obtain any medical treatment deemed necessary for my child.

I understand the NYAA reserves the right to photograph facility, activity, and program participants at any and all NYAA-sponsored events for potential future use. I understand that NYAA will not publish children's names. All photos will remain the property of the NYAA and may be used in future newsletters, Facebook, websites, or news releases for promotional purposes for NYAA. If you do not wish to have your child's photo taken, please notify a Board member or instructor in writing.

By checking below, I acknowledge that I understand all of the above information, and I agree to comply with all league requirements.

I/we agree with the above *

I authorize any of my child's coaches or other league representatives, in the absence of myself or other legal guardians, to seek medical attention for my child. This can include but is not limited to, an x-ray examination, anesthetic, medical or surgical diagnosis, and treatment if deemed necessary. Such care may be rendered to the minor, at a recognized facility, under the general or special supervision of a licensed physician or surgeon.

Check here if you agree with the statement above *

* indicates required fields

Online Processing Fee($3)