Clone of Chi-ball Y league Registration Form

Chi-ball Y League 2025 Summer Registration Form

(age 5 and 17)

10355 S Woodlawn, Chicago, IL 60628

Athlete Information

Player Name*

First NameLast Name

Are you the parent or gaurdian of the player that you are registering ?*

YesNo

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail*

Basketball skill level*

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Interested in Volunteering while your team not playing?

Match RefereeOperate Scoreboard

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Do you have health insurance ?

YesNo, I'll pay with cash.

Insurance Carrier

Name of Policy Holder

Subscriver ID/Group Number

Card Number / Card Date

Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo

Please describe*

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Release of Liability

hough the safety of all sport activities is the primary concern, indoor sport activities at Youth Sport Center's facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Youth Sport Center and theAlt persons in charge.

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at chiballyleague@gmail.com

Email

example@example.com

Phone Number

Area CodePhone Number

Birth Certificate

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