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NYABC Athlete Registration Form
ALL NYABC PARTICIPANTS MUST HAVE THIS FORM COMPLETED PRIOR TO THEIR CLINIC DATE(S)!
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* Indicates required question
Participant First Name
*
Your answer
Participant Last Name
*
Your answer
Participate Date of Birth and Age
*
Your answer
Check Off The Clinics You Will Be Attending
*
1-2PM Sunday: 10/08/2023
1-2PM Sunday: 10/15/2023
1-2PM Sunday: 10/22/2023
1-2PM Sunday: 11/05/2023
1-2PM Sunday: 11/12/2023
1-2PM Sunday: 11/19/2023
Required
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Parent/Guardian #1
*
Your answer
Parent/Guardian #1 Phone
*
Your answer
Parent/Guardian #1 Email
*
Your answer
Parent/Guardian #2
Your answer
Parent/Guardian #2 Phone
Your answer
Parent/Guardian #2 Email
Your answer
Emergency Contact #1
*
Your answer
Emergency Contact #1 Phone
*
Your answer
Emergency Contact #1 Email
*
Your answer
Emergency Contact #2
Your answer
Emergency Contact #2 Phone
Your answer
Emergency Contact#2 Email
Your answer
Please Tell Us About The Participant
*
Your answer
In case of an emergency, do the clinic directors have permission to seek medical care for your athlete? (ambulance, ER, paramedics, etc.)
*
Yes
No
Physician Name
*
Your answer
Physician Phone Number
*
Your answer
Parent/Guardian Signature
*
Your answer
T Shirt Size
*
YM
YL
S
M
L
XL
Other:
Date Signed
*
MM
/
DD
/
YYYY
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