Youth Basketball and Cheerleading – Brown County Parks & Rec

If you prefer to register in person please print, complete and return
this form to our office.

Registration will be available Nov 9 – Dec 11

Select Activity *

Participant's Name *

Age *

Sex *

Grade *

Date of Birth *

mm/dd/yyyy

Years in Program

Preferred Practice Location (HES, SES or VB Elem)

REQUESTS NOT GUARANTEED

Parent/Guardian Name *

Mailing Address *

City *

State *

Zip *

Primary Phone *

Emergency Contact Phone *

(if parent/guardian cannot be reached)

Email *

Shirt Size *

IMPORTANT INFORMATION, PLEASE READ & CONSENT BELOW.

LIABILITY RELEASE: By signing below I, as a participant or legal guardian representing a minor participant, agree to release the Brown County Parks & Recreation ("BCPR") department, its officers, employees, sponsors and volunteers from all liability for accidents, injuries, illnesses, loss of and/or damage to my/our person or property that may arise out of my/our participation in, or my/our presence at the above activity(s). I/We are aware that there are certain risks or possible dangers in participating in this activity. I have entered into this agreement of my own free will. MEDICAL RELEASE: In case of illness or accident, permission is granted to take the above person to the hospital or doctor’s office for medical attention. CODE OF ETHICS RELEASE: As a participant or spectator, I (we) agree to abide by, follow and comply with the rules, policies, and expectations of the BCPR programs and will conduct myself (ourselves) in a courteous and respectful manner by exhibiting good sportsmanship and being a positive role model for youth. I (we) also understand that failing to do so will constitute grounds for sanctions and/or dismissal of participant from the program. PICTURE RELEASE: I as a participant or legal guardian representing a minor participant agree to allow BCPR to use pictures taken at events for promotional purposes.

I would like to HELP: **To ensure player safety all volunteers must submit to a background check.

Coach

Assistant Coach

Sponsor, Fee - $250.00

Comments or Medical Information

Additional Child *

Price

Signature (Type Name Here) *

By signing this form you agree to the hold harmless/liability release stated above.

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