Registration Form Registration Form Player Full Name(Required) First Last Date of Birth(Required) Gender(Required) Parent/ Guardian Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Phone(Required)Emergency Alternate Contact(Required)Emergency Alternate Phone(Required)Relationship to Player:(Required) Health Card Number(Required) All Known Allergies(Required)Special Requests:Date MM slash DD slash YYYY E-SignatureWAIVER PCYB will attempt to accommodate all interested players. Registration, however, cannot be guaranteed as it is limited and on a “first come, first-served basis. PCYB reserves the right to move players among teams for the purpose of balancing skill level and ensuring competitive play. PCYB cannot guarantee special requests and/or player assignment to specific teams. Parents/Guardians are responsible to ensure that the player is in good health and has medical coverage. Returned cheques will result in $25.00 processing charge. Cancellations before Oct. 15th will be subject to a $20.00 administrative fee. Refund requests after Oct. 15 may be considered for individual circumstances and will be pro-rated. In consideration of the granting of permission by the Port Colborne Youth Basketball to my child (player noted above) to join the said organization and play basketball therewith, on behalf of myself and my said child, I hereby release the said organization and each and every one of its members from any and all claims, that may arise either directly or indirectly as a result of joining. Permission is hereby granted to the Port Colborne Youth Basketball to seek medical and/or hospital care for my child if and when such care is deemed necessary. I hereby give my permission to PCYB to photograph and/or record me or my family members and further to use my name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising and promotional materials without reservation or limitation. PCYB is under no obligation to exercise said rights herein granted. By registering, I understand and agree to the Terms & Conditions/Waiver . VOLUNTEERS: PCYB is in need of volunteers and support. We will gladly sign off on any community service hours that teens in need for graduation. Anyone else is welcome too! Volunteers 18 years old and older are required to complete a background check.VOLUNTEER Yes, I would like to VOLUNTEER Options Head Coach Asst Coach Score Keeper Referee PCMBA Executive Member Volunteer Name First Last Volunteer PhoneVolunteer Email Fees for Play(Required)U8 ($180.00 CAD)U11 and above ($200.00 CAD)Travel ($650.00 CAD)Travel & House League ($750.00 CAD)PAYMENT METHOD Please e-transfer your registration fees to payments@portcolbornebasketball.com. In the NOTES section of the e-transfer, please include the player's first and last name, along with their division.
