Saint John Vianney

Catholic Youth Organization Basketball

Registration Form

Name of Player: _________________________ ___________________________________

Last Name First Name

Parent Name (s): ________________________________________________________________

Address: ________________________________________________________________

________________________________________________________________

Phone Number: ____________________________

Email Address: ____________________________

Please enter Age and Grade as of September 2010:

Birthday: _______________ Age: ___________ Grade: ___________

School Attending: ________________________ Gender: M( ) F ( )

Returning Player: ( ) Yes ( ) No (If No, Please include copy of Birth Certificate)

Catholic: ( ) Yes ( ) No Registered Parishioner at SJV: ( ) Yes ( ) No

Did you attend Faith Formation class last year at SJV? ( ) Yes ( ) No

Fee (Please Circle one): Single player: $220.00 Multiple Players $440.00 Check No. _______

Please return the appropriate fee to:

Saint John Vianney CYO Basketball

1650 Ygnacio Valley Road

Walnut Creek CA 94598

If you are interested in one of the volunteer jobs below please indicate:

( ) Coach ( ) Assistant Coach ( ) Team Parent

No Guaranteed Team Assignments.

No refunds after team assignments are made except for Injury or relocation.

Signature of Parent: __________________________________ Date: ___________________, 2010