policy page 2
CDYB Registration Form
Complete and submit by Nov 15, 2016
Date of Birth / Grade / M or F
Shirt Size YM, YL, YXL, AS, AM, AXL
Emergency Contact (if parent cannot be reached)
Doctor Contact Info
Is your child under a doctors care or taking medication?
Allergies and or Medical Condition?
Do you have Health Insurance Coverage? Ins Company Name and Policy #
If the game is canceled due to weather how should we contact you?
The purpose of having medical info listed is to ensure medical personnel have details of any/all medical issues that may interfere with treatment up to and including transport by ambulance and hospitalization. By completing and submitting this form I give permission for CDYB to have my child treated by Certified Emergency Personnel and release CDYB of all liabilities involved in the treatment of my child Parent / Gaurdian
Fees for the Season i $30 per child $75 max per family Fees due by November 15,2016 Make checks payable to: CDYB Cairo Durham Youth Basketball