T-SHIRT SIZE:

Youth Small _____

Youth Med ______

Youth Lg._______

Youth XL _______

Adult sizes _______

Gallatin Co Youth Sports Association

Sports Registration Form

P.O. BOX 644

WARSAW KY 41095

BASKETBALL $10.00

Please only 1 child per registration form. Make additional copies as needed.

Players are only allowed to play on one team. Birth certificates may be required per age group.

LAST NAME_____________________________FIRST NAME_________________________MI____

ADDRESS________________________________CITY_______________ST__________ZIP________

PHONE (HOME) ____________________________OTHER____________________________

E-MAIL_____________________________________

FATHERS NAME______________________________MOTHERS NAME_______________________

GRADE ______ SEX (CIRCLE ONE) M F BIRTHDATE____________________

* SEE AGE GROUPING CHART TO DETERMINE AGE DIVISION YOUR CHILD WILL PLAY IN:

Preschool/Kindergarten 1^st/2^nd 3^rd/4^th 5^th/6^th 7^th/8^th 9^th-12^th

List any medical conditions______________________________________________________________________

Please indicate if you can help in one or more of the following areas.

___Coach ___Asst Coach ___Referee ___Asst Referee __Floor preparation ___Concession Stand

Name______________________________________Phone______________________

E-mail________________________________________________________________

The Child above has my permission to participate in Gallatin Co Youth Sports Association activities. I hereby release GCYSA from any liability for injury or loss that may result from such participation. I also understand that this is a recreational sport and any unsportansmanlike behavior will not be tolerated from players or parents. Coaches will also have the right to dismiss a player from the team for offensive behavior at practice or a game. Coaches will also be responsible for parents behavior, so remember you are here for the children.

Parent/Guardian Signature____________________________________________________Date_____________________

MAKE CHECKS PAYABLE TO: GCYSA

IF YOU NEED ANY ADDITIONAL INFORMATION PLEASE CALL 567- 5900

FOR REGISTRAR PURPOSES ONLY

PAYMENT RECEIVED: _________________________AMOUNT______________________CHECK#_______________________

ASSIGNED TO __________________________________________________

Fees are to help with expenses to run the sport. Please remember we will keep cost for all sports to a minimum .