GAINESVILLE RECREATION _ PARKS DEPARTMENT by decree

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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: eal2323@yahoo.com .

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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