Return Completed Registration Form with Check by Mailing To

Diocese of Rochester –Holy Trinity Parish

2016-17 CYO BASKETBALL REGISTRATION

Return completed registration form with check by mailing to:

Holy Trinity CYO Basketball

1460 Ridge Road

Webster, NY 14580

****REGISTRATION DEADLINE IS SEPTEMBER 30TH ****

$20 increase in registration fees for any application received after 9/30/16

Child’s Name: (Please print) ______

Age: ______Date of birth: _____/_____/_____ Male ___ Female___

Grade in Sept ______School______

Street: ______City: ______Zip: ______

Parent 1 Name (Full): ______Parent 1: Home Phone: ______

Work Phone: ______Cell Phone ______Parent 1: E-mail ______

Parent 2 Name (Full): ______Parent 1: Home Phone: ______

Work Phone: ______Cell Phone ______Parent 2: E-mail ______T-shirt size______

Eligibility Statement

Is your family registered in Holy Trinity? Yes _____ No ______(If you have not previously played for Holy Trinity then preference is given to parishoners who have registered with the parish prior to 9/30/16)

If not at Holy Trinity - Parish and Location:______

Parent Volunteer Needs

(We really do need you! Teams will not choose a practice night until they have a head coach)

Head Coach ______Assistant Coach ______

ALL FAMILIES ARE REQUIRED TO VOLUNTEER WITH THE PROGRAM. ALL GAMES REQUIRE A SCOREBOOK KEEPER. IN ADDITION ALL HOME GAMES REQUIRE A VOLUNTEER AT THE ADMISSIONS TABLE, THE CONCESSION STAND, AND RUNNING THE GAME CLOCK. EACH TEAM WILL COORDINATE WHO WILL BE VOLUNTEERING FOR THEIR GAMES. THE EXPECTATION TO VOLUNTEER IS EQUALLY DIVIDED AMONG THE FAMILIES OF EACH TEAM. NO FAMILY SHOULD BE VOLUNTEERING ANY MORE OR LESS THAN ANY OTHER FAMILY ON THE TEAM. PARTICIPATION IN THIS IS NOT OPTIONAL.

CASE TRAINING

The diocese requires CASE training for all coaches and volunteers working directly with youth, including those who volunteer to keep the scorebook and run the game clock. This youth protection training can be done through an on-line course, which takes about an hour or by attending an in-person session at Holy Trinity (dates TBD). Along with CASE training, there will be a background check done on this individual. CASE training is valid for three years. Please note below who will receive CASE training for your family or if you have received CASE training in the past three years.

CASE Participant(s) and email: ______

2016-2017 Registration Fees

3rd & 4th Grade - $80.00

5th & 6th Grade - $95.00

7th & 8th Grade -$110.00

High School - $120.00

If you are registering 3 or more children then the cost of one of the children(highest cost) is 1/2 price.

** ½price discount given for children of the HEAD COACH please reflect this in your payment if you have committed to this position and have informed the Holy Trinity Board of your committment**

** There is a $20 increase in fees after September 30h.

HOW DO YOU REGISTER?

Registration is due to the parish office by September 30th. Please note there will be no in-person registration this year.

Checks payable to “Holy Trinity Sports”

Forms and payment MUST BE dropped off or mailed to: Holy Trinity CYO Basketball

1460 Ridge Rd

Webster, NY 14580

For any questions regarding registration, please read the FAQ document on the parish website or contact Ann Grieb at or 585-507-1257

Date Received: ______Paid: ____Check #: ______

HEALTH HISTORY

Health History: Please list any medical conditions that might affect your son’s or daughter’s participation in this program. Please include any medications currently taken by your child on a regular basis. If your child has a condition affecting their participation in the program, your physician must provide written authorization indicating approval of their participation.

Emergency Contact (If Parent not Available) ______Relationship ______

Day Phone ______Evening Phone ______Cell Phone ______

Insurance Carrier: ______Policy Number: ______

Primary Care Physician: ______Physician Phone:______

Any allergies or special needs/concerns/dietary restrictions, health concerns: ______

Any medications (perscription and/or non-perscription) currently taking—include dosage:

______

HEALTH RELEASE STATEMENT

Release Statement: I give permission for my child to be transported in a privately owned vehicle or emergency transportation for medical emergencies and for the release of medical records to an attending health care professional in case of injury or illness. I understand that every effort will be made to contact the parent or guardian. If one cannot be contacted, I hereby give my permission for a qualified physician to secure proper treatment for my child.

I certify that my child is in good health and has no limitations other than those I have listed, which may predispose him/her to risk during particiaption in the program.

I authorize the Diocese of Rochester to provide this registration form to the Athletic Director and/or the Coach and/or coaches of my child’s team.

My signature confirms that I have read the CYO Athletics philosophy and I give my permission for my child to participate in the program and for the Athletic Director and/or Coach to have a copy in his/her records. I hereby release the Diocese of Rochester and all its affiliated entities, including its employees, volunteers and the parish sponsor for any and all liability for any damages suffered as a result of or relating to my child’s particiaption in this program of CYO Athletics.

Parent Signature/Guardian Signature: ______Date: ______

MEDIA RELEASE

I give permission for the Diocese of Rochester to make use of pictures of my son/daughter for information advertising purposes only: Please check one of the following:

In conjunction with the photographs, slide, audio tape or videotape, I also give my permission for the Diocese of Rochester—CYO Athletics to identify the person(s) either verbally or in writing.

I request no Identifiable information pertaining to the above-named person(s) be used in conjunction with the photograph, slide, audio tape or videotape.

I hereby release Diocese of Rochester and all its affiliated entities, including its employees, volunteers and the parish sponsor for any and all liability for any damages suffered as a result of or relating to the use of any photograph, slide, videotape or audio tape, of your child done in accordance with the foregoing.verbal or written material.

Parent/Guardian Signature: ______Date: ______

registration page 1of 3