Capital City Youth Association - (Austin, TX)

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2024-25 CCYA Tigers Rec Basketball Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Gender:

Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

EMail:

* Home Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

* Emergency Contact:

* Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

INSURANCE

I, the Guardian of this child, understand that as a league and any of its Organizations or branches do NOT provide Health/Injury Insurance.

PHYSICAL EXAMINATION WAIVER

I, the Guardian of this child, believe to the best of my knowledge that he/she can withstand the rigors of a basketball season. I, the Guardian, believe there is nothing physically or mentally wrong with my child. I, the Guardian, hereby give my approval for my child to participate in the upcoming season without a physical examination which is recommended by Capital City Youth Association (CCYA).

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Processing Fee($2) *