JPYO Sports Registration Form

Please take a few minutes to completely fill out this online registration form for participation in the JPYO sports program. You will have an opportunity to pay the registration fee online via PayPal upon submission of this form. Registration fees for all JPYO sports are: $50 for 1 player, $80 for 2 players, and $100 for 3 or more players. (Price break is for players in the same family ONLY).

Please provide your contact information

Please enter physician information:

(* indicates a required field):

*Name *Name

*Street Address Organization

Address (cont.) Street Address

*City
Address (cont.)

*State City

*Zip Code State

Work Phone Zip Code

*Home Phone *Phone

*E-mail

Choose sport:    Choose season/year:

Player No. Name
Date of Birth
(MM/DD/YYYY)

Sex
League

*1: Male Female

2: Male Female

3: Male Female

4: Male Female

Please explain all players' special medical conditions or if they are on any type of medication. Also, who is eligible to seek
medical attention in your absence? (Name and contact information)

Please indicate any requests for specific coach or team. NOTE: JPYO will make every effort to meet your request, however, we
cannot guarantee that all requests shall be honored.

JPYO is an all-volunteer organization. If you would like to volunteer, please check all areas in which you are interested.

Head/Assistant Commissioner  Fundraising Committee        Field Maintenance

Website Maintenance          Head/Assistant Coach         Special Events Coordinator     

Equipment/Uniform Inventory  Team Sponsor                 Team Parent                  

Board of Directors           Concessions                  Other

I hereby give permission for all registered children to participate in the JPYO athletic program. I understand that JPYO is a non-profit, volunteer organization which sponsors sports programs as a community service and is not responsible for expenses or damages resulting from injury to participants or spectators which is sustained in conjunction with or incidental to JPYO-sanctioned activities. Accordingly, I hereby waive and release JPYO, its officials, commissioners, coaches and other other persons affiliated with JPYO from any and all claims resulting from injury sustained while attending, participating in, or traveling to or from JPYO activities.

Please provide your contact information			Please enter physician information:
*( indicates a required field):**
*Name			*Name
*Street Address			Organization
Address (cont.)			Street Address
*City			Address (cont.)
*State			City
*Zip Code			State
Work Phone			Zip Code
*Home Phone			*Phone
*E-mail

Player No.	Name	Date of Birth (MM/DD/YYYY)	Sex	League
*1:			Male Female
2:			Male Female
3:			Male Female
4:			Male Female

JPYO Sports Registration Form

Copyright © 2008 JPYO. All rights reserved. Revised: 11/17/08

Copyright © 2008 JPYO. All rights reserved.
Revised: 11/17/08