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BYL Registration Form
First Name :
Last Name :
Age:
Address:
City :
State :
Zip:
Parent / Legal Guardian’s Name :
Home Phone :
Cell Phone :
Work Phone:
E-mail Address:
In Case of Emergency
Contact #1 Name:
Phone #:
Contact #2 Name:
Phone #:
Participant’s Allergies:
Participant’s Medical Conditions:
2 Days a Week:
Ages 5-7: M/F
Ages 7-8: M/F
Ages 9-10: W/S
Ages 11-13: W/S
Fee: $240 (Entire Season)
Select Uniform Size:
Youth XS
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
I am aware of the nature of this activity and I hereby assume responsibility for to participate and to be photographed for publicity purposes. I will not hold the Burbank Youth Center and/or its employees responsible in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of the Burbank Youth Center prior to participation in this program
Parent/Legal Guardian Signature Name:
Parent/Legal Guardian Signature Date:
I Understand this is a Legal Signature
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