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MYBA MEMBERSHIP REGISTRATION
2017-2018Season
Grade / School / MF / Last Name: / First Name:
DOB: / Street Address: / City, State:
Phone: / Mother’s / Guardian Name: / Father’s / Guardian Name:
Email: / Amount Paid: / Check #
Comments and List Medical Issues: / Board Initials:
Methuen Youth Basketball Release Form
As a participant or a parent or legal guardian of a participant of Methuen Youth Basketball, I hereby give my approval to participate in any and all M.Y.B.A. activities. I assume all risks and hazards incidental to such participation, including transportation to and from the activities, and I do hereby waive, release, absolve, indemnify and agree to hold harmless the Methuen Youth Basketball Association, the organizers, sponsors, supervisors, participants, and persons transporting my child to and from the activities, for any claim arising out of an injury to my child, whether the result of negligence, or for any other cause, accept to the extent and in the amount covered by accident or liability insurance. I agree to return upon request the uniform and other equipment issued to my child in as good condition as when received except for normal wear and tear. I will furnish a certified birth certificate of the above named candidate to association officials. I hereby give consent for emergency medical care prescribed by a duly licensed doctor. This care may be given under whatever conditions are necessary to preserve life, limb or well being of my dependent.MYBA Reserves the right to limit membership.
RECEIPT AND ACCEPTANCE OF PARENT’S CODE OF CONDUCT
By signing this form, I acknowledge that I have read the parents Code of Conduct and agree to adhere to its content.
RECEIPT AND ACCEPTANCE OF PLAYER’S CODE OF CONDUCT
I also acknowledge that I have read the Player’s Code of Conduct and will review the code with my child who agrees to adhere toits content.
RECEIPT AND ACCEPTANCE OF THE SOCIAL MEDIA CODE OF CONDUCT
I also acknowledge that I have read the Social Media Code of Conduct and have reviewed all terms with my child.
I, the parent/guardian of the child listed on this form have reviewed the Parent’s, Player’s and Social Media Codes of Conduct and promise to adhere to the content of each code and understand that violation of these codes in any way may result in disciplinary action by the league which may include my or my child’s suspension or expulsion from the program. I understand that MYBA has the right to remove me or my child from the program.
Parent’s, Player’s, Social Media and Coach’s Codes of conduct are available at signups and are posted on
Signature of Parent/Guardian______Date: ______