(Please mark only one.  Use a new form for EACH child and Each sport)

______Baseball    age on April 30, 2008______ 

______Softball     age on Jan. 1, 2008______

______Basketball Grade attending fall of this year

______Soccer       age on August 1, 2008

______Swim Team

Name:_______________________________________________________ Sex:____________

Address:______________________________________________________________________

City, State, Zip:_______________________________________________________________

Phone:______________________ Email:___________________________________________

Date of Birth:_______________

Shirt Size:         Youth S M L XL

Adults S M L XL XXL

For Parents: I/We will _________Coach ___________Assist

I give my consent for my child to participate in the 2008 ICYAA Program. As the

Parent or legal guardian of the above-mentioned player, I hereby give my consent for

Emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor

Of Dentistry. This care may be given under whatever conditions are necessary to

Preserve the life, limb, or the well-being of my dependent.

Parent/Guardian Signature:_______________________________________________

ICYAA Use only

Date Paid_______________Check____________Cash_______ Other__________

Amount Paid:______________ Number in Family__________