Meade Youth Basketball Association

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MYBA AAU Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Gender:

* Years of experience:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Grade:

* School:

* How did you hear about MYBA?:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

WAIVER INFORMATION

I give my permission for the player above to participate in the MYBA Basketball Program. I agree to abide by all rules and to support the organization as long as my child is a member in good standing.

Website/Media Release
I hereby grant MYBA (Meade Youth Basketball Association) permission to use child’s full name, photograph (digitized image/video), website, and publication appearing on the basketball organization approved home page on the World Wide Web for informational purposes. I understand that the publication of the child’s name on the basketball organization website is being done in conjunction with approved basketball related activities.

I/we agree with the above *

* indicates required fields

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MYBA AAU Registration Form