2018-2019 Online Basketball Player Registration - Luther
2018-2019 Fees - $35 Per Child
Association
Luther
School
Grade 2018-2019 School Year
K
1st Grade
 
2nd Grade
 
3rd Grade
 
4th Grade
 
5th Grade
 
6th Grade
Coach
Team Name
Player Name
Player Birthdate
Player's Age as of September 1, 2018
Parent / Guardian 1
Mobile
Telephone Home
E-Mail Address
Parent / Guardian 2
Mobile
Telephone Home
E-Mail Address
Mailing Address
Player's Legal Address
Street
City
State
Zip Code
Additional Comments
Misrepresentation of player's age, address, or school could be grounds for player ineligible to participate in youth basketball.

I hereby grant my child permission to play basketball for Luther Youth Basketball Association (LYBA). I agree to hold harmless the LYBA coaches, assistants, and board against loss or damage for any injury, illness or any other condition arising from their participation in the LYBA. I hereby release, waive and forever discharge the LYBA staff from any claims that may be made by or on the behalf of the participating child relative to their participation in the LYBA program.

I also affirm by typing my name below that I am aware that a copy of the LYBA bylaws, code of ethics, and gymnasium rules are available at the LYBA homepage on the Luther Youth Sports Website (www.LutherYouthSports.com). I agree to read and abide by all rules, bylaws and standards contained therin.

Parent / Guardian Electronic Signature
Emergency Contact Name
Phone Number
Relationship
 
 

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