Milwaukie Mustangs Youth Basketball Association Fall 2023-2024 Intake Form
Please fill out one intake form for each player that you've registered. 
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Email *
Order Number
It's in the payment confirmation email you received  *
PLAYER INFORMATION
Player First Name *
Player Last Name *
Street *
City *
State *
Zip Code *
Birthday *
MM
/
DD
/
YYYY
MMYBA Team Applying for *
Grade *
Shirt Size *
Short Size *
First Number Choice 
Please pick three DIFFERENT numbers 
Second Number Choice
Please pick three DIFFERENT numbers 
Third Number Choice 
Please pick three DIFFERENT numbers 
School Name *
MMYBA Siblings and Grade Level at Season Start
PARENTS/GUARDIAN INFORMATION
Parent or Guardian Name *
Secondary Parent or Guardian Name (If applicable)
Phone Number *
Alternate Phone Number
MEDICAL/EMERGENCY CONTACT INFORMATION
Emergency Contact Name *
Emergency Contact Phone Number *
Relationship to Player *
Insurance Carrier *
Policy # *
VOLUNTEER INFORMATION
Are you willing to volunteer? *
What Role? 
Clear selection
If yes, what is your availability?
WAIVER INFORMATION
Do you consent to MMYBA using photos of your child on the website and social media? 
 *
In consideration of my participation (of said child) in the aforementioned activity, I (we) waive and release all rights and claims for loses and
damages that I (we) or our minor child may have against Milwaukie Mustang Youth Basketball Association arising in any way from (the said)
participation (of our child). This release shall be bringing upon our directors, Coaches, Representatives, and assigns. In the event that I (my
child) may require emergency medical treatment while participating in the aforesaid activities of the “MMYBA” I hereby authorize (my said
minor child) to receive medical treatment as may be necessary under the circumstances that exist. I (we) agree to indemnify and not hold
the Milwaukie Mustang Youth Basketball Association, officers, board members, coaches, or any other person against loss or expense,
including attorney fees, by reason of bodily injury, property damage, or personal injury arising out of the sole negligence of myself or family
members. I (we) also, authorize the MMYBA to photograph my child during any and all basketball related activities. I further authorize that
any photographs may be published for purposes of promoting “MMYBA.” By signing this agreement I also recognize that, when involved in
any athletic related activity, there is always a chance of injury. I also understand and agree that the MMYBA does recommend that all
participants receive a physical. It will be the discretion of the parents as to the appropriateness of the physical.
 *
Required
FEES
Uniform is required to play and must be purchased by October 10th via MMYBA.com website.
A copy of your responses will be emailed to the address you provided.
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