2025 Youth Program Registration - Prince Albert Cricket Association

PACA Youth Registration 2025 (#9)

Member Personal Details

*Submission Deadline: June 13, 2025

Youth’s First Name

Youth’s Last Name

Birth Date

Parent/Guardian Information

Parent/Guardian’s First Name

Parent/Guardian’s Last Name

Relationship

Phone Number

Address

City

Province

Postal Code

Country

Membership Type

Membership Fees

We request you to please pay the membership fees in full amount by Interac e-Transfer (email transfer) to finance@pacricketassociation.com If you have any questions related to membership, please contact us at info@pacricketassociation.com

$25 Membership Fees paid by e-transfer?

Yes

If Yes, Type confirmation code and date here:

If No, Please pay the fees first before submitting this form.

Acknowledgment of Risk & Release of Liability

I understand that participation in the PACA Youth Cricket Program involves physical activity and carries a risk of injury. I voluntarily allow my child to participate, and I release and hold harmless Prince Albert Cricket Association, its staff, coaches, volunteers, and affiliates from any liability for injury, illness, or damages arising from participation.

I acknowledge and accept the risks involved and release liability.

Medical Authorization

In case of an emergency, I authorize the program staff to secure necessary medical treatment for my child. I understand that I am responsible for any associated costs.

I authorize emergency medical treatment for my child if necessary.

Photo/Media Consent

Photos and videos may be taken during the program and may published on PACA website or social media for promotional purposes.

Yes, I give permission for my child’s photo/video to be used in program materials.

No, I do not give permission for photo/video use.

Date

Electronic Signature (Type your full legal name to confirm your consent)