Financial Assistance Financial Assistance Form CommentsThis field is for validation purposes and should be left unchanged.Choose One(Required) Scholarship: I need a scholarship and will attach my Medicaid eligibility letter Payments: I need to set up payments Upload your Medicaid eligibility letter(Required) Drop files here or Select files Max. file size: 50 MB. If you don't have a medicaid eligibility letter, call 830-393-1800 or Email Allcityyouthprograms@gmail.comChild #1 InformationSport Soccer Volleyball Basketball Swim Team Child Name(Required) First Last Birthday(Required) MM slash DD slash YYYY Age(Required)Gender(Required) Male Female Race/Ethnicity(Required) Black Asian Brazilian Caucasian Latino Caribbean Islands Native American Pacific Islander Other Check all that applyMedical Info/Medications/Conditions(Required)If none, write "None"Register 2nd Child Check this box if you'd like to register an additional child Child #2 InformationSport Soccer Volleyball Basketball Swim Team Child Name(Required) First Last Birthday(Required) MM slash DD slash YYYY Age(Required)Gender(Required) Male Female Race/Ethnicity(Required) Black Asian Brazilian Caucasian Latino Caribbean Islands Native American Pacific Islander Other Check all that applyMedical Info/Medications/Conditions(Required)If none, write "None"Register 3rd Child Check this box if you'd like to register an additional child Child #3 InformationSport Soccer Volleyball Basketball Swim Team Child Name(Required) First Last Birthday(Required) MM slash DD slash YYYY Gender(Required) Male Female Race/Ethnicity(Required) Black Asian Brazilian Caucasian Latino Caribbean Islands Native American Pacific Islander Other Check all that applyMedical Info/Medications/Conditions(Required)If none, write "None"Register 4th Child Check this box if you'd like to register an additional child Child #4 InformationSport Soccer Volleyball Basketball Swim Team Child Name(Required) First Last Birthday(Required) MM slash DD slash YYYY Gender(Required) Male Female Race/Ethnicity(Required) Black Asian Brazilian Caucasian Latino Caribbean Islands Native American Pacific Islander Other Check all that applyMedical Info/Medications/Conditions(Required)If none, write "None"Register 5th Child Check this box if you'd like to register an additional child Child #5 InformationSport Soccer Volleyball Basketball Swim Team Child Name(Required) First Last Birthday(Required) MM slash DD slash YYYY Gender(Required) Male Female Race/Ethnicity(Required) Black Asian Brazilian Caucasian Latino Caribbean Islands Native American Pacific Islander Other Check all that applyMedical Info/Medications/Conditions(Required)If none, write "None"Parent/Guardian InformationParent/Guardian Name(Required) First Last Phone(Required)Email(Required) Address Street Address City State / Province / Region ZIP / Postal Code Emergency Contact(Required) First Last Emergency Contact Phone(Required)How many live in the household?# of Adults(Required)# of Children(Required)Uniform Shirt SizeShirt Size(Required)Specify Youth or Adult for T-shirt sizeDo you want to request a particular coach, team, or to be placed with Friend?(Required) Coach Team With a Friend No Specific Request Please provide a name:(Required)Parental ConsentI parent/guardian of the above named child, hereby give my permission for his/her participation in the elected sport above this registration form is signed with the understanding that All City Youth Programs (ACYP), the City of Floresville, the 4A Corporation, or the San Antonio River Authority will not be held responsible for any sickness or injury that the applicant may receive while in attendance or participating in any of our programs. If the parent cannot be contacted in case of a medical emergency, I give permission to call 911, at my expense. No insurance is provided by ACYP, the City of Floresville, 4A Corporation or the San Antonio River Authority. Refunds will not be given out once practices have begun. Unless I send ACYP a letter to state otherwise; I will allow my child to be photographed for the ACYP web page and other ACYP promotions. By e-signing below you agree to the above. *If you'd like to move child up in an age group please contact office for permission paperwork*Parental Consent(Required) By checking this box you agree to the above parental consent Seasonal ContractYour responsibilities as the parent of the child member of All City Youth Programs are as follows; Good Sportsmanship: All team members, parents, siblings, and extended family members must display good sportsmanship at all practices, games, meets, fundraisers, and all club functions. We expect each child member and family to behave in such a manner that reflects a positive attitude and respect towards this organization, its volunteers, staff, and others. Follow the Rules: Smoking or consuming alcohol is prohibited in the presence of our child members during any ACYP functions. Profane or inappropriate gestures are prohibited at games or functions where our members are in attendance. It is prohibited to yell at or get offensive with any club officials (referees), coaches, or any other volunteer or staff. Let us set a good example for our youth! Support the Program: ACYP is a 501 (c) (3) non-profit corporation. We depend on community service, fundraisers, and donations to make this program work. We would like to thank you for supporting our Programs. I have read the above contract and agree to follow all rules and policies set forth. Parent/GuardianParent/Guardian E-Signature(Required)By adding your E-signature, you acknowledge that you have read the above contract and agree to follow all rules and policies set forth.
