REGISTRATION FOR 2024-25 SEASON, THANK YOU *

First Name

Last Name

Parent(s) Names *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Choose Program *

K/1 - Payment of $75 due at registration.

2/3 - Payment of $75 due at registration.

3/4 Rec - Payment of $125 due at registration. Only if your daughter does not want to try out for travel.

3/4 Travel - payment $175 after tryouts Oct 15 & 17 6-7pm @ Conewago (if your daughter does not make the travel team she will be placed the rec. team with a cost of $125.)

5/6 Travel/Rec - payment $200 after tryouts Oct 15 & 17 7:15pm-8:30pm @ Conewago (if your daughter does not make the travel team she will be placed the rec. team with a cost of $125.)

Phone 1 (for calls/texts) *

(###)

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Phone 2 (for calls/texts)

(###)

###

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Electronic Signature and Waiver *

I give permission for my daughter to participate in the Lower Dauphin Girls Youth Basketball (LDGYB) program. I certify that the child listed above is covered by medical/hospital insurance which will be the primary insurer in the event that any injury or illness (including COVID-19 virus) occurs during any activity related to the basketball program as no such insurance is provided by LDGYB. I understand that I and/or my child's participation is voluntary and done at our own risk and hereby waive and release LDGYB from all claims and liabilities of any kind. I accept, acknowledge and understand that the LDGYB staff will, to the best of their ability, require and enforce all applicable requirements which may assist in offering protection from the COVID-19 pandemic, as specified in CDC guidelines, but understand the atmosphere of the program may not allow perfect enforcement and assume the risk of participation and waive and release LDGYB, its agents, servants, employees from all claims and liabilities of any kind related to that participation or any requirement imposed as LDGYB staff makes their best efforts to comply with guidelines. I acknowledge the above statements with my electronic signature below.

First Name

Last Name

Photo Release Permission *

As a parent or guardian of this athlete, I hereby consent to the use of photographs/videotape taken during the course of the basketball season for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.

Yes

No

Date *

MM

DD

YYYY

Current Grade *

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

School *

South Hanover

Nye Elementary

East Hanover

Conewago

Londonderry

LD Middle School

Other

Player Date of birth

MM

DD

YYYY

Shirt Size *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Short Size

(Only for Travel/Rec teams)

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large