St. John Vianney Church CYBL Player Registration
Please use proper upper/lower case for all fields. Names will appear on team rosters, attendance sheets, etc. as entered here.

First Name:	First Name is Required
Last Name:	Last Name is Required
Nick Name:
Address 1	Address 1 is a required field
Address 2
City	City is a required field
State	State is a required field
Zip Code	Required Field Zip Code must be 5 numeric digits
Sex:	Required Field
Birthdate: mm/dd/yyyy	Required Field Not a valid Date
Shirt Size	Required Field
Height (inches)	Required Field Valid Range 24 - 66
Parent/Guardian Full Name	Required Field Letters Only
Relationship	Required Field
Home Phone (10 numeric digits)	Required Field Phone Number must be 10 numeric digits
SJV Parishioner	Required Field
Father Cell	Phone Number must be 10 numeric digits
Mother Cell	Phone Number must be 10 numeric digits
Emergency Contact	Required Field
Emergency Phone	Required Field Phone Number must be 10 numeric digits
Email Primary:	Required Field Not a valid Email address
Re-enter Email Primary:	Required Field Not a valid Email address

Email Secondary	Not a valid E-mail address
Medical Issues	Required Field
Medications	Required Field
Requests

Use of Pictures Required Field

for St. John Vianney Church to use my and/or my child's photograph publically to promote its programs. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Medical Emergency Waiver
I hereby authorize the coach, director, building monitor or volunteer present at St. John Vianney Family Life Center to seek immediate medical treatment for my child listed above, if a medical emergency arises while on the way to, returning from, or during any practice, game or meet in which the team participates. I also authorize the attending physician to perform any emergency treatment necessary after the consultation with the coach if I cannot be reached.
Electronic Signature (Full Name) Required Field Letters Only

Assumption of Risk
The parent, guardian or custodian by executing this registration for and on behalf of the named participant represents and warrants that they are unaware of any physical or mental impediment that would or could cause injury or harm to the participant or to others by the said participant’s participation in the activities of the St. John Vianney Family Life Center. Due to the strenuous nature of some activities, the parent, guardian, or custodian is urged to consult a physician concerning the fitness of the participant to engage in activities prior to executing this registration. Since all activities present certain inherent and/or inadvertent risks and hazards, know and acknowledge by the undersigned, the parent, guardian or custodian, by their execution hereof, approve the participant’s participation and assume all liability incident to the said minor’s participation, except that liability, which is imposed by law on the Catholic Archdiocese of Washington, their employees, agents or volunteers.
Electronic Signature (Full Name) Required Field Letters Only

Please check your information before submitting..
If you stay on this page after Submit Player Registration, look for data field validation errors!!