South Western Youth Basketball Registration Form 2019 - 2020
Please complete the information below to register your son or daughter for the 2019-2020 SW Youth Basketball Season. There is no payment required to register or try out for our program.

If your child is chosen for a Seniors, Juniors or Rink team, the following fees will be collected:
$125 for registration (this includes a NEW game uniform)
$20 if a new practice jersey is required

All players in grades 3-8 will be required to purchase new game uniforms this season as we are changing to a new style. Players who already have a practice jersey from last season will not be required to purchase a new one.

The fee for our 1st and 2nd grade skills developmental program is $50. These players do not require uniforms or practice jerseys. They will receive t-shirts.

Please review our website for evaluation dates and times.
Player's Information
Player's First Name *
Your answer
Player's Last Name *
Your answer
Gender *
Date of Birth *
(MM/DD/YYYY) New Players will need to show Birth Certificate for Verification
Your answer
Name of School *
Current Grade *
Parent/Guardian's Information #1
Full Name *
Your answer
Relationship to Player *
Your answer
Phone *
Format: (xxx) xxx-xxxx
Your answer
E-mail address *
Note: E-mail is the primary form of contact.
Your answer
Parent/Guardian's Information #2
Full Name *
Your answer
Relationship to Player *
Your answer
Phone *
Format: (xxx) xxx-xxxx
Your answer
E-mail address *
Note: E-mail is the primary form of contact.
Your answer
Emergency Contact Information
Emergency Contact's Full Name *
Your answer
Relationship to Player *
Your answer
Emergency Contact's Phone *
Format: (xxx) xxx-xxxx
Your answer
Medical Contact Information
Family Physician *
Your answer
Physician Phone *
Your answer
Insurance Carrier *
Your answer
Insurance Policy Number *
Your answer
Game Uniform Information
PLEASE READ: For the 2019-20 season Rinks, Juniors & Seniors will be wearing NEW uniforms. Please select sizes below. Samples will be available at tryouts and changes can be made at that time if necessary. 1st and 2nd Grade Skills Development Players will receive t-shirts.
Game Uniform Size - Jersey
Please select your child's Jersey Size below. 1st and 2nd Grade Skills Development Players should select their appropriate t-shirt size.
Game Uniform Size - Shorts
Please select your child's Shorts Size below. 1st and 2nd Grade Skills Development Players should please select "N/A" as those players will not receive shorts. All other players must select a size.
Practice Jersey Size *
Please select your child's practice jersey size below ONLY IF you would like to purchase a new practice jersey for this season. The cost will be $20. Please select "N/A" if you intend to use last year's practice jersey. 1st and 2nd graders should select "N/A"
Volunteer Information
How could you help? *
Parent volunteers are a necessity for the success of the organization. Please indicate below all of the ways you may be willing to help. Note: We will need all parents of the basketball organization to work the concession stand and/or the admission table several times during the season.
Interested
Not Interested
Head Coach
Assistant Coach
Scorekeeper
Administrative
Board Member
Youth Night/Picture Organizer
Concession Organizer
Medical Release *
In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child. I give consent for the facility to secure any and all necessary emergency medical care for my child.
Required
Parents Code of Conduct *
I will place the emotional and physical well-being of my child ahead of any personal desire to win. ● I will insist that my child play in a safe and healthy environment. ● I will respect the facilities used for practices and games, and be responsible for those under my control to do the same. ● I will ask my child to treat other players, coaches, fans, and officials with respect. ● I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and officials at every practice and game. ● I will remember that the game is for children and not adults. Any behavior that is in violation of the Parents Code of Conduct will be referred to the SWYBB Board. The Board has the ability to suspend any parent that does not comply with the Parents Code of Conduct.
Required
Waiver Agreement *
I hereby give permission for my child to participate in basketball with South Western Youth Basketball. I agree to indemnify and hold harmless the organization from any claims, liabilities, losses, expenses and damages which may occur from playing or practicing on any ground with the organization may be operating.
Required
E-Sign Name *
Your answer
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