YOUTH BASKETBALL LEAGUE
REGISTRATION FORM
PLEASE CHECK ONE: MALE FEMALE PLEASE PRINT IN ALL AREAS CLEARLY
CHILD’S FULL NAME: ___________________________________________________
Home Address:________________________________________________________
Date of Birth: _________________________
AGE DIVISION: (CHECK ONE)
5/6 YR OLD 7/8 YR OLD 9/10 YR OLD 11/12 YR OLD 13/14 YR OLD
For ages 11/12 & 13/14, please check one of the two divisions: SILVER
PARENTAL/GUARDIAN INFORMATION:
FATHER/GUARDIAN NAME: _______________________________________________________
HOME #:____________________________CELL#:____________________________
EMAIL: __________________________________________________________________
MOTHER/GUARDIAN NAME: _______________________________________________________
HOME #:____________________________CELL#:____________________________
EMAIL: __________________________________________________________________
EMERGENCY CONTACT NAME: ________________________BEST CONTACT #: __________________
PARTICIPANT MEDICAL HISTORY
Child has the following medical conditions:
_______________________________________________________________________________
Current medications, special dietary needs, allergies:
______________________________________________________________________________________________
Other information: _________________________________________________________________
Child’s Limitations: ________________________________________________________________
FULL SPORTS UNIFORM SIZE
(If in doubt, please consider ordering 1 size larger)
YOUTH: YS YM YL
ADULT: AS AM AL AXL AXXL AXXXL
IF POSSIBLE, PLEASE PLACE MY CHILD ON THE SAME TEAM AS:
____________________________________________
PREFERRED COACH (NAME):____________________________________________________
BIRTH CERTIFICATE VERIFICATION: ________________________________
PLEASE NOTE: We will do our best to place your child on
your preferred team. However, it is NOT GUARANTEED.
City, State
Zip
(Jersey tops and bottoms
come as a set and will be
the same size. Please
order accordingly.)
Age on 05/1/2020: _________
(Beginning/Intermediate)
GOLD
(Advanced)
Verification by Staff Only
(Other than parents)
15-17 YR OLD
(Samples are available for try-on
in sports office)
REV. 01.13.2020
REFUND POLICY
Requests for Refunds must be made within ninety (90) days of payment. Sports program management will
consider requests for Refunds on an individual basis, reviewing pertinent medical and/or extenuating
circumstances. If approved for processing, the child's full uniform must be returned (in clean condition). If
payee is unable to return full uniform, the following costs will be deducted from the refund: Non-return of
jersey top: $13.00; non-return of shorts: $13.00 - for a maximum charge of up to $26.00 for the full cost of
replacement. The following charges are considered non-refundable: The $15.00 Registration Fee and, if
applicable, the $25.00 charge taken after the Early Bird Registration deadline.
I HEREBY PLEDGE TO PROVIDE POSITIVE SUPPORT, CARE, AND ENCOURAGEMENT FOR MY CHILD PARTICIPATING IN
YOUTH SPORTS, BY FOLLOWING THIS PARENTS’ CODE OF ETHICS PLEDGE:
I WILL ENCOURAGE GOOD SPORTSMANSHIP BY DEMONSTRATING POSITIVE SUPPORT FOR ALL PLAYERS,
COACHES, AND OFFICIALS AT EVERY GAME, PRACTICE, OR OTHER YOUTH SPORTS EVENT.
I WILL PLACE THE EMOTIONAL AND PHYSICAL WELL-BEING OF MY CHILD AHEAD OF A PERSONAL DESIRE TO WIN.
I WILL INSIST THAT MY CHILD PLAY IN A SAFE AND HEALTHY ENVIRONMENT.
I WILL SUPPORT COACHES AND OFFICIALS WORKING WITH MY CHILD, IN ORDER TO ENCOURAGE
A POSITIVE AND
ENJOYABLE EXPERIENCE
FOR ALL.
I WILL DEMAND A SPORTS ENVIRONMENT FOR MY CHILD THAT IS FREE OF DRUGS, TOBACCO AND ALCOHOL, AND
WILL REFRAIN FROM THEIR USE AT ALL YOUTH SPORTS EVENTS.
I WILL REMEMBER THAT THE GAME IS FOR YOUTHS, NOT FOR ADULTS.
I WILL DO MY VERY BEST TO MAKE YOUTH SPORTS FUN FOR MY CHILD.
I WILL ASK MY CHILD TO TREAT OTHER PLAYERS, COACHES, FANS AND OFFICIALS WITH RESPECT - REGARDLESS
OF RACE, SEX, CREED OR ABILITY.
I WILL REQUIRE THAT MY CHILD’S COACH BE TRAINED IN THE RESPONSIBILITIES OF BEING A YOUTH
SPORTS
COACH AND THAT
HIS/HER COACH UPHOLD THE COACHES’ CODE OF ETHICS.
PARENT/GUARDIAN SIGNATURE DATE
I PROMISE TO HELP MY CHILD ENJOY THE YOUTH SPORTS EXPERIENCE BY DOING WHATEVER I CAN, SUCH AS
BEING A RESPECTFUL FAN, ASSISTING WITH COACHING OR PROVIDING TRANSPORTATION.
Signature of Parent/Guardian:
____________________________________Date:
__________________
Photo/Video Release
Your child may be photographed and/or videotaped at various Bernalillo County-sponsored events. Please review and
sign below:
I, __________________________, the parent/legal guardian of _________________________, give permission for my child's
photograph or video to be taken and used by Bernalillo County for any and all promotional materials or other publications.
I understand that I will not receive compensation for the use of any photo or video and further waive any ownership rights
associated with any photo, video or other material my child might appear in.
Signature of Parent or Guardian: ___________________________________ Date: ________________________
HOLD HARMLESS AGREEMENT
We hereby request that our child, _________________________________________________, be permitted to participate in
the Bernalillo County Sports Program's Youth Basketball League (YBL) for the Summer 2020 Season. If our request is
granted, we understand and agree to hold harmless the County of Bernalillo, Albuquerque Public Schools, United States
Specialty Sports Association (USSSA), Sports Officials, Bernalillo County Employees and Contractors, and those
assisting in the Youth Basketball League from any claims, suits, actions or causes of action arising out of any
accident/incident or conduct involving us or our child. This includes, but is not limited to: the costs and reasonable
attorney(s)' fees associated with any claims, suits, actions or causes of action.
________________________________________________________________________ ___________________________
Parents' Code of Ethics
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