Basketball – Brown County Parks & Rec

Online registration is closed. Please call our office to be placed on the wait list.

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

Register Online

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)

Shirt Size *

Skirt Size-CHEERLEADERS ONLY

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 and volunteers from all liability for accidents, injuries, illnesses (including but not limited to unknown risks/exposure to COVID-19), 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 - $200.00

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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