Child's Full Name:

Parent's Name:

Address:

City: (PA)

Phone(s): or

E-mail address:

Grade: Pre-K/K 1st 2nd 3rd 4th 5th 6th

Birthdate: //

Shirt Size: (For Jersey; Include "Y" in front of youth sizes.)

School:

Sex:     Male    Female

Played last year in league? Yes    No

Is it okay to have your
child photographed? Yes    No

Do you have another child who will be playing in the league? Yes    No

I am 18 years or older and understand that I will pay the full amount owed to the YMCA for participation in the Youth Basketball League.

You will be notified when Orientation Day is via phone, letter and/or e-mail.