Fall / Winter 2024 – Player Registration Form

Fill up the field boxes with the information needed. Field with (*) is required.
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Activity Information

Year

Activity Name

Venue

Day and Time

Start Date

(mm/dd/yyyy)

Today Date

(mm/dd/yyyy) Registration is based on actual submission date

Player Information

First Name *

Last Name *

Gender *

Female

Male

Birthday *

(mm/dd/yyyy)

Age

(Based on Start Date)

Address *

Address Line 2

Extra line for address

City *

State *

Zip Code

Division and Fee Table

Note: Minimum of eight (8) games including play-offs. Fee in USD.

Jersey is REQUIRED for first-time registrant. Comes in Youth sizes.

Division *

Mosquito (Coed - ages 4-6) - $100.00

Bees (Coed - ages 7-9) - $100.00

Tykes (Coed - 10 under) - $100.00

Girls (ages 12-16) - $100.00

Peewee (Boys - ages 11-12) - $100.00

Bantam (Boys - ages 13-14) - $100.00

Junior (Boys - ages 15-17) - $100.00

Choose a Division

Add-On

Jersey - $50.00

Jersey is required for first-time registrant.

Size

Comes in Youth Sizes.

Total Fee: $

Parent or Guardian Information

P/G First Name *

P/G Last Name *

Relationship *

ex. Father, Mother, Aunt or Others

Phone1 Number *

Home or Mobile

Phone2 Number

Home or Mobile

Email Address *

All communication will be sent to this address

Permission and Release Declaration

I hereby give permission for the above Player to participate in the FYBA Basketball League activity and agree that he/she will abide by all the rules and regulations of the facility/area and/or the Filipino-American Youth Basketball Association and its designated officers and agents.

In case of accident or illness, please contact the name of above listed Contact Person at his/her Contact Number.

In the event of an accident or injury, I, as parent or guardian of the above child, hereby waive liability for the Fil-Am Youth Basketball Association and their officers and will hold them harmless. I understand that there is no medical insurance being provided by the Filipino-American Youth Basketball Association.

PHOTO RELEASE: I give my consent for pictures taken of my child involved in Filipino-American Youth Basketball Association (FYBA) programs to be used for future FYBA promotions or display.

Declaration *

I declare above Permission and Release Declaration.

Payment Information

Mode of Payment *

PayPal or Credit/Debit Card

Check/Cash

PayPal or Credit/Debit Card payment includes additional 4% Service Fee.

Total Fee: $

Late Registration Charge: $

Service Fee: $

Add 4% for PayPal or Credit/Debit Card payment.

Total Amount Due: $

Note: Please prepare your Paypal Account credential or Credit/Debit Card now. After you click the 'Submit' button, the subsequent page needs some details of your Paypal account or card information. Before clicking the 'Submit' button, please review carefully your entries above and make necessary changes if needed.

Note: Write your check payable to FYBA Inc. with the amount in the 'Total Amount Due'. Send this check to 'FYBA Inc. 7386 Shady Palm Drive, Springfield, VA 22153'. Before clicking the 'Submit' button, please review carefully your entries above and make necessary changes if needed.

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