Mount Holly Parks and Recreation Basketball Registration Form
THERE IS A 1% CONVENIENCE FEE ADDED ON FOR ONLINE REGISTRATION
- The registration fee for basketball: $50 for city limit residents of Mt. Holly, $75 for non-residents.
- Registration deadline for basketball is Friday, November 8th at 5:00pm. Online registration ends on Thursday, November 7th at 11:59pm.
- Registration can be cut off early if teams are filled. After the deadline a late fee of $30 may be assessed if space is available. Registration is on a first come first serve basis.
- Requests for specific teams, coaches, practices, and game day and times will NOT be guaranteed.
- Practices or games could be any day of the week except Sunday's.
- Games could also involve travel to surrounding cities based on our participation numbers.
- HEAD COACHES ARE NEEDED!! If you are interested in coaching, please note it below.
- NO refunds or changes will be made after the registration deadline!
Age cut is baed on however old your child is as of January 1, 2020.
I HEREBY CONSENT TO MY CHILD PARTICIPATING IN SPORTS PROGRAM SPONSORED BY THE MOUNT HOLLY PARKS & RECREATION DEPARTMENT. BY SIGNING THIS RELEASE I ALSO SIGN FOR ANY FAMILY MEMBER OR GUEST THAT IS IN ATTENDANCE FOR MY CHILD. I ALSO UNDERSTAND THAT REQUESTS FOR CERTAIN COACHES OR TEAMS WILL NOT BE GUARNTEED. I UNDERSTAND FULLY THAT THE RECREATION DEPARTMENT WILL NOT TOLERATE UNSPORTSMANLIKE BEHAVIOR OF ANY KIND. I AGREE THAT ANY BEHAVIOR SUCH AS CURSING AND/OR YELLING AT OFFICIALS, COACHES, PARENTS OR PLAYERS WILL RESULT IN SUSPENSION FROM THE DEPARTMENT'S ACTIVITIES FOR ME AND MY CHILD.
By signing below, the undersigned acknowledges that they have read and understand the Release and Indemnity Agreement, together with matters pertaining to the concussion protocol and consent to the terms of the Conduct requirements set forth herein.
MOUNT HOLLY PARKS AND RECREATION DEPARTMENT POLICY REGARDING SPORTS INJURIES
RELEASE AND INDEMNITY AGREEMENT
By my signature below on this release I hereby consent to my child, listed below, participating in any City of Mount Holly sports programs. This document is intended to release any claims which my child or the undersigned parent(s) or legal guardian may or might have resulting from activities relating to my child's play or other activities relating to the above. The undersigned, for him/herself and the minor child or children listed below, and their heirs, executors, and assigns, does hereby knowingly and voluntarily agree to release, waive, discharge, hold harmless, defend, and indemnify all City of Mount Holly employees, City Council members, coaches, assistant coaches, and volunteers associated with City of Mount Holly sports programs, from any and all claims, actions, or losses due to bodily injury, property damage, wrongful death, loss of services, or any other injuries, damages, or claims which may arise out of the activities described above. I specifically understand that I am releasing, discharging, and waiving any claims that I or my child or children may have presently or that may arise in the future related to these types of activities. The undersigned understands and acknowledges that the activities set forth above may have inherent risks, dangers, and hazards, and participation in such activities and/or use of equipment may result in injury, including but not limited to, disease, strains, sprains, fractures, partial and or total paralysis, death, or other ailments that could cause serious disability. The undersigned, for him/herself and the minor child or children listed below, does hereby accept and assume all these risks and dangers and any others arising from such activities.
If I am accompanying a minor child or children, then I further agree that I will be solely responsible for the safety and oversight of such child or children who may be in my custody during the activities described above.
I have carefully read this Agreement and agreed to be bound by the terms hereof. This Agreement shall continue in full force and effect covering the above described activities from and after the date below. This Agreement also permits the children listed below to participate in the activities described above whether or not the undersigned parent or legal guardian is present and without any further permission from the undersigned.
MATTERS PERTAINING TO CONCUSSION PROTOCOL
The following policy and procedures are being implemented by the Mount Holly Parks & Recreation Department with the intent to reduce the potentially serious health risks associated with sports related concussions and head injuries.
A concussion is a type of traumatic brain injury that is caused by a blow to the head or body that jars or shakes the brain inside of the skull. It is important to note that an athlete does not have to lose consciousness to have suffered a concussion.
SIGNS AND SYMPTOMS OF CONCUSSIONS
Signs Observed by Others/Symptoms Reported by Athlete
- Appears dazed or stunned - Headache
- Is confused about assignment - Nausea
- Forgets plays/unsure of game, score or opponent - Balance problems or fuzzy vision
- Moves clumsily or answers questions slowly - Sensitivity to light or noise
- Losses consciousness - Feeling sluggish, foggy or groggy
- Shows behavioral or personality changes - Concentration or memory problems
- Cannot recall events prior to hit or after the hit - Confusion
I hereby understand that if my child is suspected of a concussion or head injury that I must submit a written medical clearance from an appropriate health-care professional to the Mount Holly Parks & Recreation Department prior to returning to any activity. I understand that my child will not be allowed to participate until I have produced this document.