NAYA Winter Basketball 2025-2026

NAYA's Winter 2025-26Basketball Registration

NAYA basketball registration will begin 11/19 and close 12/13 (or until filled). There will be nine teams (3rd boys,5th boys, 6th boys, 7th/8th boys, 3rd girls,5th girls, 6th girls teams). Practice will begin Wednesday 12/5/25 and wrap up on 3/12/26 3rd - Each team will practice twice a week with games on Saturdays.
This roster space is for youth in 3rd - 12th grade only. Each youth must be registered individually; please click next to the one grade group for the youth you are registering. If it says "none remaining" below we are unfortunately at capacity.*
Yes (by clicking "Yes" I understand that if my youth is not attending 75% of the time it is possible they may not be able to continue)No (if no, do not proceed)
I understand as the parent/guardian that I am responsible for organizing transportation to and from programming.
Youth Information
Youth's Legal Name*

First NameLast Name
Youth's Preferred Name (if different from above)
Youth Phone Number (optional)
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth's Date of Birth*

MonthDayYear
Date
Youth's Gender*
They/ThemShe/HerHe/HimPrefer not to answerOther
Youth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult XXLOther
Does your youth have any Special Concerns: (allergies – food or environmental, medications, medical conditions, activities youth cannot participate in, special accommodations that are needed, etc.)? If yes, list all. If no, put "none."*
Youth's Tribal Affiliation (optional)
Parent/Guardian, Emergency Contact, and Approved Pick up Information
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian's Email*
example@example.com
Parent/Guardian's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Name (parent/guardian will be first emergency contact) *

First NameLast Name
Emergency Contact 2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
List the first and last names and phone numbers of anyone who has permission to pick up your youth (parents, guardians, family, friends, NAYA staff, etc.) If some one arrives to pick up your youth who is not listed here, they will NOT be able to pick them up. IDs may be required.*
Education/School Information
Youth currently enrolled in school?*
Youth's Current School Name*
Type of school or training program in which youth is enrolled*
What grade will your youth be in during the 2025-26 school year?*
Youth's Synergy ID (District ID Number, contact youth's school if you don't know)*
Releases and Consents:

All releases and consent must be completed and signed by a parent or legal guardian.
YesNo (if no, do not proceed)
Name of parent/legal guardian completing the below releases and consents*

First NameLast Name
Today's Date*

MonthDayYear
Date
By checking here, you are consenting to the use of your electronic signature in lieu of an original paper signature.
I understand this is safety precaution and that it will be my responsibility as parent/guardian to pick up the youth if they are sick.
Parent/Guardian Signature*
YESNO
Parent/Guardian Signature*
Permission/consent to photograph, video, interviews and quotations: I give consent for myself or my child to participate in NAYA Family Center marketing activities, including interviews, the use of quotes, and the taking of photographs, movies or video tapes by NAYA Family Center employees. I grant NAYA Family Center the right to edit, use, and reuse said products for non-profit marketing purposes including use in NAYA Family Center grant writing and marketing in print, on the internet, and all other forms of media. I also hereby release NAYA Family Center and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.*

YESNO
Parent/Guardian Signature*
Consent for transportation in NAYA vehicles and NAYA staff vehicles: I understand that NAYA Family Center programs and activities may include local and long distance travel, and give permission to the NAYA Family Center to provide transportation. The participant understands and agrees to abide by the following rules with being transported:· All participants must be responsible for wearing seatbelts at all times.· All children under 80 lbs. are required to be properly placed in a child seat or booster seat.· Appropriate conduct will be mandatory when being transported.· Smoking is not allowed in NAYA Family Center vehicles or personal staff vehicles when being transported. A participant may be subject to suspension of transportation privileges if found in violation of any rules of transportation, or for disobeying the NAYA Family Center staff providing the transportation.*

YESNO
Parent/Guardian Signature*
NAYA internal information sharing agreement: Information sharing within NAYA services, or internal information sharing between staff, is often necessary in order to better serve the participant and family. Please indicate your agreement for NAYA staff to share your information within NAYA programs as needed to provide services. By acknowledging Yes, you understand that electronic mail (e-mail) is not confidential and can be intercepted and read by other people.*

YESNO
Parent/Guardian Signature*
Consent to emergency care and relevant information: In the event of an emergency, if reasonable attempts to contact persons listed are unsuccessful, I give consent to the NAYA Family Center to transport myself or my child to the doctor or to the Emergency Medical Department of the nearest hospital. If my doctor cannot be contacted, all medical treatments deemed necessary by the attending licensed physician, including examinations, anesthesia, operations, and diagnostic procedures, may be administered. I further acknowledge that I will be responsible for all fees and costs associated with the medical treatment that are not covered by my insurance.*

YESNO
Parent/Guardian Signature*
Release of Liability/Assumption of Risk: (in order for youth to participate, this must be answered "yes." If "No" is indicated, you will be contacted to fill out another form if you'd still like your youth to attend.) By participating in the programs and activities of the NAYA Family Center, I agree to hold harmless the NAYA Family Center, and release any and all rights or claims to damages that may arise in connection with or as a result of myself or my child’s participation in the programs and activities of the NAYA Family Center. This release applies to the NAYA Family Center, including any and all officers, agents, employees, volunteers, sponsors, coaches, and/or damages.*

YESNO
Parent/Guardian Signature*
Should be Empty:

NAYA's Winter 2025-26Basketball Registration