Choose which program you are signing up for:
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Select one
New England Classic- $65
YES! AAU Fall Team without uniform- $134
YES! Winter Travel Team without Uniform - $134
YES! AAU Spring Team without Uniform- $344
First Name:
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Last Name:
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Street Address:
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City, State and Zip:
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Home Phone:
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Cell Phone:
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Student Email:
Gender:
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Height:
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Uniform Size (ie., Youth Small, Youth Medium, Youth large, Adult Small, etc.):
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Date of Birth:
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School you are attending:
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Grade entering fall 2013:
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Have you participated in the YES! Basketball program in the past?
Do you have limited, average, or above average skills in basketball?
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Does your mom or dad have any coaching experience and would he/she be interested in coaching?:
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Did you participate in a free or reduced lunch program this year?:
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Race:
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Allergies and/or medication(s) you are on:
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Mother's name, cell phone and email address:
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Father's name, cell phone and email address:
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Emergency contact (Name, relationship to student, and phone number):
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ASSUMPTION OF RISK, AGREEMENT TO INDEMNIFY AND HOLD HARMLESS, AND EMERGENCY MEDICAL RELEASE: I give permission for my SON/DAUGHTER to participate in the YES! Program. I am aware that learning or practicing the above activity can be an activity involving risk of injury, including serious injury. I fully understand that YES!, its agents, directors, officers, and employees accept no responsibility and will not be liable for any injury, harm, or damage to his/her person or property occurring during or arising out of participation. To the fullest extent permitted by law, I do hereby agree to assume all risk of injury, harm, or damage to his/her person or property (including but not limited to all risks of injury, harm, or damage to his/her person or property caused by negligence of YES!, its agents, directors, officers, or to employees) arising during or in connection with said Program, including but not limited to transportation to or from said Program, and we do hereby release and agree to indemnify and hold harmless YES!, its agents, directors, officers, or employees, from any and all liability, actions, damages, and claims of any kind and nature whatsoever (including but not limited liability, actions, damages, and claims caused by or arising from the negligence of YES!, its agents, directors, officers, or employees) for injury, harm or damage to his/her person or property that may arise or occur during or in connection with said Program. I also give permission for any photographs, film, audio, print or videotapes taken during these activities to be televised, published and/or used for promotional materials in the future relating to said Program. And further, I give permission for emergency medical treatment to be given to my child, in case I cannot be reached by phone. - Signature of Parent/Guardian (18 years or older is required).
BY WRITING YOUR NAME IN THIS FIELD AND SUBMITTING THIS DOCUMENT WILL BE RECOGNIZED AS YOUR ON-LINE SIGNATURE. ------------- Schools Systems supporting the YES! Program: Portland South Portland Cumberland
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Comments:
Event: YES! Program