YES Session 6: Basketball 2 Registration

Youth, Education, & Sport (YES) Program Registration

Session 6: Basketball 2 (1/29 - 2/15)
There will be walking transportation for students located at Carmel Community School. We will have someone meet the students at Carmel and walk them over to the Family Success Center.
This fun, skill-intensive program is designed to learn the fundamentals of passing, shooting, ball handling, rebounding and defense through skill-based instruction and small-sided scrimmages.
Program Details
Programming will take place Monday-Thursday.

Check-In & Snack: 4:00pm - 4:15pm
Programming Begins: 4:15pm - 5:30pm
Pick-Up: 5:30pm - 5:45pm

*Snack will be provided for students.*
*Please make sure student has appropriate clothing that they can be inside or outside in.*
Participant Information
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Grade for the 2023-24 School Year*

1st Grade2nd Grade3rd Grade4th Grade
Gender*

MaleFemaleNon-Binary
Which school does your student attend?*

Carmel Community SchoolCentennial Elementary SchoolMountain Vista Community SchoolChipeta Elementary SchoolBuena Vista Elementary SchoolAdams Elementary SchoolOther
Parent/Guardian Contact
Name*

First NameLast Name
Cell Number*
Home Phone Number*
Work Phone Number*
E-mail*
example@example.com
Secondary Parent/Guardian Contact
Name

First NameLast Name
Cell Number
Home Phone Number
Work Phone Number
E-mail
example@example.com
Emergency Information

*Contact should be different from the parent/guardian listed above.*
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number*
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the student prescribed an inhaler? If yes, please explain any instructions.*
Which language would you like your waiver and agreements in? *
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Youth, Education, & Sport (YES) Program Registration

Program Details

Participant Information