1. Healthcare

NONPROFIT ORG
U S POSTAGE PAID
PERMIT NO. 332
STOCKTON, CA
AND 1!!!
When kids play Y-Sports they learn more than skills – they develop
character. We impart our four core values: honesty, respect, caring
and responsibility, at all of our practices and games.
Basketball (Age 9-10, 11-12, 13-14, 15-17)
November 1, 2014 - December 20, 2014
• One practice per week, day/time selected by
coach. All games are on Saturday.
• This program is co-ed.
COMPETITIVE BASKETBALL
STOCKTON
Baloncesto (Edad 9-10, 11-12, 13-14, 15-17)
1 de Noviembre 2014 - 20 de Diciembre 2014
• Una práctica a la semana, día / hora seleccionado por el entrenador. Todos los juegos son el
sábado.
• Los niños y las niñas pueden jugar.
Return completed form with payment to:
YMCA of San Joaquin County
2105 W March Lane Suite 1
Stockton, CA 95207
P: (209) 472-9622
F: (209) 472-9625
www.ymcasjc.org
facebook.com/sjcymca
YMCA of San Joaquin County
2105 W March Lane Suite 1
Stockton, CA 95207
Cuando los niños juegan en Y-Deportes aprenden más que solo habilidades - desarrollan carácter. Impartimos nuestros cuatro valores
fundamentales: honestidad, respeto, cuidado y responsabilidad en
todas nuestras prácticas y juegos.
Do You
Have
Game?
Sign up by October 20, 2014 Season starts on November 1, 2014!
www.ymcasjc.org
facebook.com/sjcymca
COMPETITIVE BASKETBALL - REGISTRATION FORM
Child’s Name: _________________________________________________________________________________
How would you descirbe your child’s skill level?
Age: ____________ Date of Birth: _________________________________ M: F:
BeginnerIntermediate Expert
Address: _______________________________________________________________________________________
City: ______________________________________________________ Zip: _______________________________
Home Phone: __________________________________________________________________________________
School: ___________________________________________________ Grade: ___________________________
Parent / Guardian: ___________________________________________________________________________
Work Phone: ____________________________________________ DOB: _____________________________
Email: ___________________________________________________________________________________________
Special Needs / Physical Limitations / Allergies / Medications:
___________________________________________________________________________________________________
Sports Shorts! Would you like to purchase YMCA shorts to go with your
uniform? If so, please include an additional $10 with your registration and select
your child’s size below:
YXSYSYMYLASAMALAXL
Request Coach: _______________________________________________________________________________
Request Player: _______________________________________________________________________________
How did you hear about this program? __________________________________________________
___________________________________________________________________________________________________
Volunteer! Our youth sports programs would not be possible without the time
and effort of selfless volunteers such as yourself. Please consider showing your
support for the YMCA by volunteering today!
Emergency Contact Phone: _________________________________________________________________
Head coaches who attend the coach’s clinic, coach’s meeting and are
in good standing with the YMCA at the end of the season will recieve a
$20 credit on their account that can be used towards a future sports
registration.
Child’s T-shirt (Check One):
Volunteer Name: ______________________________________________________________________________
YXSYSYMYLASAMALAXL
Coach Asst. Coach Team Parent Emergency Contact: _________________________________________________________________________
Waiver of Liability: I hereby accept any and all responsibility for, and assume
the risk of any and all injury or damage to my person or dependent children
which might arise directly as a result of, and or participation in the YMCA of
San Joaquin County, the various branches and subdivisions thereof, and all
employees and volunteers in their capacities as representatives of the YMCA
expressly including, but not limited to the Board of Directors of the YMCA of
San Joaquin County except injuries caused intentionally, or by willful misconduct.
I give my permission for my children (s) picture to be used as a promotion for
the YMCA. I certify that I am familiar with the contents of this release, that I
have read and understand the same, and that it is my intention by my heirs,
administrators, executors, successors, and assigns.
___________________________________________________________________________________________________
Parent / Guardian (Please print clearly)
___________________________________________________________________________________________________
SignatureDate
Volunteer’s T-shirt (Check One):
S M L XLXXL
YMCA Parent Shirt! Are you unable to volunteer, but eager to show your Y
spirit? Support your child with an official Y Parent shirt in the same color as
their team. Please include an additional $10 with your registration and select
your size below:
- PRICE • Annual Membership Fee: $10
• Registration Fee: $95
• A $10 late fee may be charged to to
registrations recieved after October 20th,
2014.
• A $10 cancellation fee will apply. No refunds will be given after the start of games.
• Financial assistance available for those who qualify.
• The YMCA reserves the right to request a birth
certificate, baptismal certificate, passport or
official school document in order to verify a
child’s age.
- PRECIO •
•
•
•
•
•
Cuota Anual: $10
Tasa de Registro: $95
Una cuota de $10 se aplica a cualquier registro
recibido después del 20 de Octubre del 2014.
Se aplicará un cargo por cancelación de $10. No se harán reembolsos después del inicio de los juegos.
Hay asistencia financiera disponible para aquellos que califiquen.
El YMCA reserva el derecho de pedir un
certificado de nacimiento, certificado de
bautizo, pasaporte o un documento oficial de
la escuela para verificar la edad de un niño/a.
S M L XLXXL
Sponsor a team! The YMCA receives a large amount of requests for
scholarships to participate in our sports programs. Please help us provide
financial aid to these deserving applicants by making a donation or sponsoring a
team for just $300. Call our office today at (209) 472-9622 to find out how!
BETTER TOGETHER
Note: This program is not related to nor endorsed by Stockton Unified
School District; it is solely offered and managed by the YMCA of San Joaquin
County.