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Jointly sponsored by: Summer Heatwave Alachua County Board of County Commissioners City of Gainesville, Dept. of Parks, Recreation & Cultural Affairs; Gainesville Housing Authority; Gainesville Police Department; Alachua County Sheriff’s Department and Jennings Development Group, Inc. Recreational Basketball League REGISTRATION FORM Participant Name:_________________________ _ Sex*:____ Race*:____ Age:____ DOB:____/____/_____ Address:____________________________________ City:____________________ Zip Code:____________ Parent/Guardian Name:____________________________________ Home Phone #:____________________ Place of Employment:_____________________________________ Work Phone #:____________________ Email Address:_______________________________________ Additional Phone #:____________________ School Participant Attends:_____________________________________________ Grade:______________ In Case of Emergency, Notify: Name:___________________________________________________ Phone #:________________________ Relationship:_________________________________________ Additional #:_________________________ PARTICIPATION AGREEMENT I agree that this instrument is for registration and not for insurance coverage. I give my child permission to participate in all programs and activities conducted by the City of Gainesville Parks, Recreation and Cultural Affairs Department, including field trips. I am fully aware of the risk inherent and hereby release the City of Gainesville, any employees, any of its elected or appointed officials, or volunteers from any and all liability, claims, including attorney’s fees and costs, and injuries which may be sustained by me or my minor children on account of his/her participation in said programs or associated activities and events. It is understood that the City of Gainesville Parks, Recreation and Cultural Affairs Department reserves the right to dismiss any participant for just cause. I further agree to return any and all property issued to me, upon the expiration of this activity, or whenever I have ceased participating in this activity. I will pick my child up from program or activity if the staff determines it necessary for the safety of my child, other participants, and/or staff. I give my permission for my child to be photographed and those photographs with his/her name to be used for publicity purposes for the City of Gainesville Parks, Recreation and Cultural Affairs Department. Signature of Participant:__________________________________________ Date:_____________________ (If participant is under 18 years of age, a Parent’s/Guardian’s signature is required.) Signature of Parent/Guardian:_____________________________________ Date:_____________________ T-Shirt Size: Youth Sm Med Lg Xlg Adult Sm Med Lg Xlg XXlg Information provided on this form may be subject to the State of Florida public records law (chap. 119.07, Fla. Stat.) Under this law, the City is required to provide access to and copies of non-exempt public records upon request from a member of the public. *City Resident □ *Non- City Resident □ This form, Document No.R06-0002, is a legal instrument approved by the City Attorney. Any deviations from its use should be authorized by the City Attorney Summer Heatwave Recreational Basketball League Boys & Girls Ages 13 - 20 FREE!! Practices will be held on Monday through Friday between the hours of 3:00 p.m. until 8:00p.m. at the locations listed below. Game days are Monday and Thursday from 5:30 p.m. until 8:00 p.m. at locations listed below. PRACTICE SITES: Practice will begin on July 7th, 2008 (Please circle practice site most convenient to you) 1. Westside Park ◊ 1001 N.W. 34th Street 2. Kanapaha Veteran’s Memorial Park ◊ 7400 S.W. 41st Place 3. Forest Park ◊ 4501 S.W. 20th Avenue 4. Tiger Bay Court ◊ 2415 S.E. 4th Lane 5. Eden Park at Ironwood ◊ 1330 N.E. 39th Avenue 6. Northeast Community Center ◊ 1701 N.E. 8th Avenue 7. Woodlawn Park ◊ 1900 S.E. 4th Street GAME DAY SITES: Games will begin on July 10, 2008 1. University of Florida ◊ 200 Florida Gym–Stadium Rd. 2. MLK Jr. Multipurpose Center ◊ 1028 N.E. 14th Street 3. Kanapaha Middle School (TBD) ◊ 5005 S.W. 75th Street 4. Lincoln Middle School (TBD) ◊ 1001 S.E. 12th Street Participants must provide their own games shorts and basketball shoes. Team T-Shirts will be provided. Please list your other interests:___________________________________ If you’re interested in coaching, please contact Ed Lavagnino at (352)441- 0760 or by email: firstname.lastname@example.org . Please return your registration form to the Department of Parks, Recreation and Cultural Affairs, Administrative Office located at 1024 NE 14th Street or contact them at 352-334-5067.
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