PLAYER INFORMATION Name: Birthday: Age Gender: m Male m Female Address: City: Postal Code: Home Phone Number: Session: Freshmen - Ages 8-10 m Junior – Ages 11-13 m Senior – Ages 14-16 m PARENT/PRIMARY CONTACT Name: Work Phone: Home/Cell Phone: Address: (if different than Player) Email: ADDITIONAL INFORMATION Please list any medical or dietary conditions we should be aware of: Shirt Size: m S m M m L m XL m Other____________ I understand that photographs, images or recordings containing my child’s picture may be used for promotion, on the YMCA’s website, social media properties including facebook and twitter, and promotional material such as brochures by the YMCA of Western Ontario. By checking the box below, I am granting permission. I permit my child noted above to attend the league at the YMCA of Western Ontario. I permit my child to participate in the full range of league activities and authorize the YMCA in the event of an accident or illness affecting the above child to authorize on my behalf all procedures including admission to the hospital and necessary treatment therein, as she/he may deem essential for the care and well-being of said Player. Such action is to be taken only when immediate contact with the undersigned cannot be made. Signature of Parent/Guardian: Date Signed: YMCA London Lightning Basketball League Sept 29 - Dec 21, 2014 YMCA of Western Ontario ymcawo.ca LONDON LIGHTNING BASKETBALL LEAGUE REGISTRATION
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PLAYER INFORMATION Name: Birthday: Age Gender: m Male m Female
Address: City: Postal Code: Home Phone Number:
Session:
Freshmen - Ages 8-10 m Junior – Ages 11-13 m Senior – Ages 14-16 m
PARENT/PRIMARY CONTACT
Name: Work Phone:
Home/Cell Phone: Address: (if different than Player)
Email:
ADDITIONAL INFORMATION
Please list any medical or dietary conditions we should be aware of:
Shirt Size: m S m M m L m XL m Other____________
I understand that photographs, images or recordings containing my child’s picture may be used for promotion, on the YMCA’s website, social media properties including facebook and twitter, and promotional material such as
brochures by the YMCA of Western Ontario. By checking the box below, I am granting permission.
I permit my child noted above to attend the league at the YMCA of Western Ontario. I permit my child to participate in the full range of league activities and authorize the YMCA in the event of an accident or illness affecting the above child to authorize on my behalf all procedures including admission to the hospital and necessary treatment therein, as she/he may deem essential for the care and well-being of said Player. Such action is to be taken only when immediate contact with the undersigned cannot be made.
Signature of Parent/Guardian: Date Signed:
YMCA London Lightning Basketball League
Sept 29 - Dec 21, 2014
YMCA ofWestern Ontario
ymcawo.ca
LONDON LIGHTNING BASKETBALL LEAGUE REGISTRATION
London Lightning and YMCA Basketball LeaguesThe London Lightning Basketball Leagues will provide players aged 8 - 16 an opportunity to improve their fundamental skills and develop their basketball potential. If you want to take your game to new levels, have fun and learn from experienced, professional basketball players, then the London Lightning Basketball Leagues are for you! Registrants will be presented the opportunity to have fun, work hard and learn new basketball skills and concepts, as well as being inspired to reach new basketball and life goals.
Includes: • 90 min skills & drills and game each
week
• Monthly tournament format
• London Lightning practice jersey
• Two tickets to a London Lightning game
• Frequent visits and coaching from Lightning Players
Commitment to Safety The YMCA is committed to the safety of all children. We continually audit our programs to ensure we’re staying on top of health and safety. Along with having fun and learning new skills, participants will be supervised and supported by caring YMCA staff.