BISMARCK LIONS YOUTH ATHLETICS (BLYA)
BISMARCK LIONS YOUTH ATHLETICS (BLYA)
P.O. Box 463 - Bismarck, AR 71929 – [email protected]
Basketball Registration (3rd – 6th Grades) and Parent Volunteer Form 2017-2018 The Basketball registration fee is $45 per athlete ($70 per family maximum). Athletes who participated in Football/Cheer during the current school year receive a $5 multi-sport discount (making the registration fee $40) OR the Per Family Maximum Discount. If multiple athletes (siblings) register for basketball, the $70 per family maximum fee/discount applies and provides a greater discount than the multi-sport discount. Please make all checks payable to BLYA.
Athlete Information Name: _____________________________________________________________________________ Grade: _____________________________________________________________________________ Date of Birth: _______________________________________________________________________ List any allergies or medical issues the coaches should be aware of: ____________________________ ____________________________________________________________________________________ Athlete Qualifies For $70 per Family Registration Maximum Registration Fee. Please list all athletes registering in this family: _________________________________________________________________________________________ Athlete Qualifies for $5 Multi-Sport Discount. Please list other sports this athlete participated in for this calendar year (this discount only applies if you do not qualify for the Per Family Maximum): ___________________________
Parent/Guardian Contact Information Contact Name 1/Phone #/Email: ________________________________________________________ Contact Name 2/Phone #/Email: ________________________________________________________ I would like to volunteer to be:
Volunteer Information:
*Head Coach
Name(s): ______________________________________________________
*Assistant Coach
Address: _________________________________________________
No Thanks
Contact Info (Phone/Email): _________________________________________
*(Please note: volunteering does not guarantee a position)
BLYA Registration Completion Checklist (to be completed by BLYA Administration only):
Athlete Uniform Information:
This Completed Registration Form
*Shirt Size: ____________
Registration Fee
*Shorts Size: ___________
Parent/Guardian/Athlete Agreement & Emergency Medical Release Form A Valid Physical
Number: _____________ *Parents/Guardians are responsible for costs associated with incorrect sizing.
P.O. Box 463 - Bismarck, AR 71929 – [email protected]
Basketball Registration (3rd – 6th Grades) and Parent Volunteer Form 2017-2018 The Basketball registration fee is $45 per athlete ($70 per family maximum). Athletes who participated in Football/Cheer during the current school year receive a $5 multi-sport discount (making the registration fee $40) OR the Per Family Maximum Discount. If multiple athletes (siblings) register for basketball, the $70 per family maximum fee/discount applies and provides a greater discount than the multi-sport discount. Please make all checks payable to BLYA.
Athlete Information Name: _____________________________________________________________________________ Grade: _____________________________________________________________________________ Date of Birth: _______________________________________________________________________ List any allergies or medical issues the coaches should be aware of: ____________________________ ____________________________________________________________________________________ Athlete Qualifies For $70 per Family Registration Maximum Registration Fee. Please list all athletes registering in this family: _________________________________________________________________________________________ Athlete Qualifies for $5 Multi-Sport Discount. Please list other sports this athlete participated in for this calendar year (this discount only applies if you do not qualify for the Per Family Maximum): ___________________________
Parent/Guardian Contact Information Contact Name 1/Phone #/Email: ________________________________________________________ Contact Name 2/Phone #/Email: ________________________________________________________ I would like to volunteer to be:
Volunteer Information:
*Head Coach
Name(s): ______________________________________________________
*Assistant Coach
Address: _________________________________________________
No Thanks
Contact Info (Phone/Email): _________________________________________
*(Please note: volunteering does not guarantee a position)
BLYA Registration Completion Checklist (to be completed by BLYA Administration only):
Athlete Uniform Information:
This Completed Registration Form
*Shirt Size: ____________
Registration Fee
*Shorts Size: ___________
Parent/Guardian/Athlete Agreement & Emergency Medical Release Form A Valid Physical
Number: _____________ *Parents/Guardians are responsible for costs associated with incorrect sizing.
