Parkland Youth Center Basketball Registration/Code of Conduct Form
Last Name: _________________________
First Name: ______________________________
Address: _________________________________________________________________
Phone: _____________ School: ________________________
Age: ______
Sex (M/F) ___
Grade: __________
MI: ________
Zip: ____________
Birth Date: __________
Parents e-mail: ____________________________________________
Father’s name: _________________________________ Mother’s Name: ________________________________
Volunteer to Help: Coach: _____
Assistant: _____
Team parent: _______
We Need Coaches and Volunteers!!!!!!!!!!!
Must check:
Other: _________________
In house Parkland REC League ______ or Lehigh Valley Travel League ______ or LV Boys JV Travel 3rd-8th ________
Registration Fee: Any returned checks $20 fee. No Refunds except for unforeseen circumstances!! Late fees after 10/10/13 are $20.
Registering after 10/10/15 will not guarantee a team roster position.
Lost Jersey/Uniforms $30
$55 for grades K – 2,
$90 For Travel teams. No Refunds if player does not make Travel Team
$75 for Grades 3rd - 8th
$180 Family (3 or more)
$90 for 9th-12th
Mail form with check payable to PYC and mail to: Michael Lahanas 2026 Sunrise Drive, Allentown, PA 18104
Parental Consent Form
Parent/Guardian:
As legal guardian of the player(s) named on this registration form, I/we hereby grant my/our full consent & approval for my/our child (ren) to participate as a
team member in any PYC organizational activity during the current season. This includes but is not limited to the following: practices, games, fundraising, and
transportation to and from games, practices, and other organizational events. By signing this document, I/we agree to abide by all the rules, regulations, and
decisions of PYC and its respective sports leagues.
I/we, the undersigned, understand that there are certain risks of injury inherent in the practice and play of this sport, as well as in traveling and other related
activities incidental to my/our child(ren)’s participation. I/we am/are willing to assume these risks on behalf of my/our child (ren). In addition to giving
my/our full consent for my/our child(ren)’s participation, I/we do hereby release, waive, absolve, indemnify and agree to hold harmless the PYC Organization,
its respective sports leagues, the Parkland School District, their officers, coaches, sponsors, organizers, directors, supervisors, officials, members, participants,
and persons transporting my/our child(ren) to and from PYC activities, from any responsibility or liability for any claim for damages for injuries sustained by
the player(s) listed on this registration form. This includes but is not limited to play, practice or activity associated with the PYC Organization or in traveling
to and from the playing field, or place of activity at which any practice, game, exhibition or event may be conducted. I/we, the undersigned, assume all
financial responsibility for payment of medical, dental expenses for the named player(s). The PYC Organization assumes no liability or costs in the event of
injury, death or illness of any kind, due to participation in the PYC activities. I/we hereby certify that my/our child(ren) is/are fully capable of participating in
the designated sport and that my/our child(ren) is/are healthy and has/have no physical/mental disabilities or infirmities that would restrict full participation in
these activities, except as listed below:
I/we herby intend to be legally bound and this agreement shall bind my/our heirs, administrators, executors and assigns.
Signature
Date
Relationship to Player
CODE OF CONDUCT
As a participant IN PYC sports, as a player, coach, or parent/guardian, I agree that I will adhere to the PYC mission statement by always demonstrating, during
team practices and games, the highest level of sportsmanship. I will do this by avoiding the following behavior: 1. Abusive or excessive demeaning speech to
players, parents, coaches or fans involved in practices or games 2. Abusive or excessively demeaning speech to umpires, referees, or other league
sponsored officials 3. Demonstrating in any way an inability to control my temper 4. Any behavior in games or practices that would by reasonable
standards misrepresents the desire of PYC to put forth a high standard of sportsmanship 5. The use of foul language, tobacco, or alcohol at games or
practices. Please note that the use of tobacco and alcohol is strictly prohibited on school district and township property.
I have read the above mentioned criteria and I agree that I will, to the best of my ability adhere to its content. If I am found in violation of any of the above
mentioned rules, I agree to remove myself from participating in PYC sponsored events.
Signature
Parent /Guardian
Date
Signature of Player
Rev 7/28/2009 mm