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PUYALLUP PARKS & RECREATION 2016/2017 YOUTH BASKETBALL REGISTRATION FORM Fair Play Law: The City or any third party that uses city property or facilities, or is required to obtain a permit, license or other form of approval from the City for a community athletics program, or participates in a community athletics program shall not discriminate against any person on the basis of sex or any other basis protected by federal or state law. MALE FEMALE PARENT SCHOOL ADDRESS CITY ZIP HOME PHONE WORK PHONE T-SHIRT SIZE: AXL____ (Kindergarten – 4th Grade) JERSEY SIZE: AXL____ AXXL____ (5th Grade – 12th Grade) ***Please be accurate on the T-Shirt and Jersey size because there will be an $20 re-order fee*** Did your child participate in our 2015/16 youth basketball program? YES NO If yes, list coach or team name SPECIAL PLAYER/TEAM REQUEST: (There are no special requests for Grades 5th-12th!) I, WOULD LIKE TO VOLUNTEER AS A: ASST. TEAM PARENT/GUARDIAN ASSUMPTION OF RISK, WAIVER AND RELEASE I/we am/are the parent(s) or legal guardian of (Child’s name) Who desires to be a participant in the City of Puyallup sponsored recreational activity of (Describe) It is important to me/us that this child be allowed to participate in this activity. I/we understand there are special dangers and risks inherent in this activity, including but not limited to, the risk of serious physical injury, death or other harmful consequences which may arise directly or indirectly from the child’s participation in this activity. Being fully informed as to these risks and in consideration of the City’s allowing my child to participate in this sponsored activity and/or use of city facilities, I/we, on behalf of myself(ourselves) and on behalf of the above-named participant child, assume all risk of injury, damage and harm to the child which may arise from the child’s participation in the activities or use of City facilities. I/we acknowledge that a medical exam is encouraged if I/we have any questions concerning the above-named child’s participation in this activity. I/we further agree, individually and on behalf of the above-named child, to release and hold harmless the City of Puyallup, its officials, employees, its hired or contracted instructors and any other agents or organizations including the Puyallup School District, and waive any right of recovery that I/we may have to bring a claim or lawsuit for damages against them for any personal injury, death or other harmful consequences occurring to the above-named child or me arising out of the child’s voluntary participation in this activity. I/we further agree that pictures and video taken during program hours may be used for future promotional purposes. I/we grant my (our) full and voluntary consent for the above-named child to participate in the activity described above. Parent(s) / Guardian Printed Name(s) Date Parent(s) / Guardian Signatures(s) Date MEDICAL INSUR. CO. POLICY # FOR OFFICE USE ONLY AMOUNT ---PAGE BREAK--- PUYALLUP PARKS & RECREATION YOUTH BASKETBALL PROGRAM INFORMATION SHEET Register online @ LEAGUES AVAILABLE FOR BOYS AND GIRLS GRADES K-12 ***Adults are needed as coaches*** **Financial Assistant is available** REGISTRATION DATES & PRIORITIZATION: PLEASE NOTE THAT REGISTRATION WILL BE LIMITED DUE TO LIMITED GYM SPACE. PARTICIPATION ON A TEAM LAST YEAR DOES NOT GUARANTEE A SPOT ON THIS YEAR’S TEAM. YOU MUST REGISTER DURING THE DATES LISTED BELOW. ALL REGISTRATIONS WILL BE ACCEPTED ON A SPACE AVAILABLE BASIS. WE CAN NOT HOLD ROSTER SPOTS. REGISTRATION DATES: Oct 3-9 – City of Puyallup residents only (Incorporated City Limits) Oct 10-23 – City of Puyallup residents, 2015/16 returning players living outside the City limits, and new non-resident players REGISTRATION WILL BE ACCEPTED AT: Puyallup Recreation Center, 808 Valley Avenue NW, Puyallup 6:00 a.m. to 8:00 p.m. Monday – Friday 8:00 a.m. to 6:00 p.m. Saturday & Sunday COST: K-4th Grade 5th-12th Grade $56.00 – City of Puyallup Resident $67.00 – City of Puyallup Resident $67.00 – Non-Resident $80.00 - Non-Resident ***Price includes the State Sales Tax*** LEAGUE FORMATION: The Kindergarten League will be coed. There will be separate leagues for girls and boys in grades 1st-12th. Teams in grades K-4th will be put together by the Parks & Recreation Department. Boy’s and girl’s teams in grades 5th-12th will be formed by a player draft system. PRACTICES: Practices will begin the week of Monday, November 28th, depending on the availability of gyms. Practices will be held at the Puyallup Recreation Center, Memorial Center and local school gyms. There are no special requests for practice times, days or location. GAMES: League games will start Saturday, January 7th. Games will be played at the Puyallup Recreation Center, Memorial Center and local school gyms. Each team will play eight games. UNIFORMS AND EQUIPMENT: Uniforms and Equipment will be provided by the Puyallup Parks & Recreation Department. Each player will keep their t-shirt or reversible jersey. AWARDS: (No league standings will be kept for Kindergarten – 4th grade). Each player will receive a Certificate of Participation. For 5th grade and above, 1st place trophies will be awarded in each league. There will be a $5.00 administrative fee for all refunds issued. For more information, call (253) 841-5457.