South Florida Disciples Registration Application


Participant Name:
Date of Birth:
Street Address:
Zip Code:
Home Phone:
Parent/ LG 1 Name:
Parent/ LG 1 Street Address (If Different):
Parent/ LG 1 City:
Parent/ LG 1 Zip Code:
Parent/ LG 1 State:
Parent/ LG 1 Home Phone:
Parent/ LG 1 Work Phone:
Parent/ LG 1 Cell Phone:
Parent/ LG 1 Email Address:
Parent/ LG 2 Name:
Parent/ LG 2 Street Address (If Different):
Parent/ LG 2 City:
Parent/ LG 2 State:
Parent/ LG 2 Zip Code:
Parent/ LG 2 Home Phone:
Parent/ LG 2 Work Phone:
Parent/ LG 2 Cell Phone:
Authorization & Responsibility:

1.       By submitting this form I agree to my child participate in the South Florida Disciples Basketball Program (SFD).

2.       Fees for uniforms and other gear (warm-ups, shoes, uniform bags, etc.) are non-refundable and are property of the participant.

3.       I agree to have my child's picture to be used for media purposes or for the South Florida Disciple website.

4.       I understand that I must submit my child’s birth certificate and report card in order to comply with travel rules and regulations as proof of age and grade. 

5.       I hereby authorize and direct the SFD staff and volunteers to exercise and act in their best judgment in the event of a medical emergency regarding my child.  I hereby confirm that my child is covered by accident and/or health insurance, which provide coverage for any injury. 

6.       The risk of injury whether sports related or not by participation in sports is always possible.  While the rules of the program and personal instruction may reduce the risk, the risk of injury does exist.  I knowingly and freely assume all such risks both known and unknown even if arising from the negligence of the SFD or any of its officers, board members, organizers, sponsors, coaches and participants.  

7.       I, on behalf of my child, myself, and family members release and hold harmless the SFD or any of its officer, board members, organizers, sponsors, coaches, and participants with respect to any and all injuries, disability, death, loss or damage to any person and/or property arising from the SFD. 

8.        I further certify that as his/her parent and/or legal guardian, I have the legal right to allow my child to participate in the SFD Basketball Program. 

  By checking this box, I agree with the terms of this application