Registration - 2026-27 Pinelands 1st-6th Grade Rec Basketball Registration
2026-27 Pinelands 1st-6th Grade Rec Basketball Registration
Registrant Name
Registrant Address
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Registrant Email
T-Shirt Size
Grade
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Multi Child Registration
Player 2 Name
Grade
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Player 3 Name
Grade
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Grade
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Comments(ALL REQUESTS MUST GO HERE)
ALL REQUESTS FOR COACHES OR PRACTICE TIMES MUST BE MADE IN THE COMMENT SECTION
Payment could be made online at PayPal or in person with cash or check during evaluations.
1st and 2nd Grade Clinic
$85.00
Single Player
$160.00
Two Players
$230.00
Three Players
3rd - 6th Grade Rec
$98.00
Single Player
$180.00
Two Player
$265.00
Three Players
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT ("AGREEMENT")
IN CONSIDERATION of being permitted to participate in any way in athletic activities (the "Activities") I, for myself for personal representatives, assigns, heirs, and next of kin:

1. ACKNOWLEDGE, agree, and represent that I understand the nature of the Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.
2. FULLY UNDERSTAND THAT: (a)THE ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my own actions or inaction’s, the actions or inaction’s of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISK AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.
3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Pinelands Basketball Association, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child/ward’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim.
4. ACKNOWLEDGE, agree, and represent that I understand Pinelands Basketball Association, is not responsible for loss or damage to personal possessions and that my/my child's photograph or video may be used in future promotions.
5. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child/ward’s readiness for participation and/or in the program itself, I will remove my child/ward from the participation and bring such attention of the nearest official immediately;

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

MINOR RELEASE
AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF THE ACTIVITIES AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE’S FROM ALL LIABILITY CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATION AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

Photo/Video release- I hereby give my consent for Pinelands Basketball Association to use my Childs photograph and or action videos and likeness to be used in its publications, including its website, youtube, facebook and any other form of public media. I release them from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below.
I hereby authorize Pinelands Basketball Association to publish the photographs, videos and sounds taken of the registered player for the activity registered for, and their name for use in the Pinelands Basketball Association printed publications and website. I also authorize the use of any likeness in gaming, apps or any marketable type item.

Solicitation. I acknowledge that I will not solicit for any organization other than Pinelands Basketball Association or its sponsors while participating in any activity that is associated with Pinelands Basketball Association and the ground the activity takes place.

I acknowledge that since my participation in publications and websites produced by Pinelands Basketball Association is voluntary, I will receive no financial compensation. I further agree that my participation in any publication and website produced by Pinelands Basketball Association confers upon me no rights of ownership whatsoever. I release Pinelands Basketball Association , its contractors, volunteers and its employees from liability for any claims by me or any third party in connection with mine or my childs (registrant’s) participation.

CODE OF CONDUCT

PINELANDS BASKETBALL ASSOCIATION FOLLOWS THE CODE OF CONDUCT GUIDELINES SET FORTH BY THE STATE OF NJ UNDER THE MODEL ATHLETIC CODE OF CONDUCT IN ACCORDANCE WITH THE PROVISIONS OF P.L 2002, CHAPTER 74 AS STATED BELOW. ADDITIONALLY, THE ORGANIZATION HAS SET FORTH ADDITIONAL GUIDELINES TO ABIDE BY. THE ORGANIZATION WITHOUT NOTICE, CAN AMEND THE CODE OF CONDUCT AS WELL AS PENALTIES SET FORTH BELOW.

The following model athletic code of conduct is promulgated in accordance with the provisions of P.L. 2002, Chapter 74.
Preamble:
Interscholastic and youth sports programs play an important role in promoting the physical, social and emotional development
of children. It is therefore essential for parents, coaches and officials to encourage youth athletes to embrace the
values of good sportsmanship. Moreover, adults involved in youth sports events should be models of good sportsmanship
and should lead by example by demonstrating fairness, respect and self-control.
I therefore pledge to be responsible for my words and actions while attending, coaching, officiating or participating
in a youth sports event and shall conform my behavior to the following code of conduct:
1. I will not engage in unsportsmanlike conduct with any coach, parent, player, participant, official or any other attendee.
2. I will not encourage my child, or any other person, to engage in unsportsmanlike conduct with any coach,
parent, player, participant, official or any other attendee.
3. I will not engage in any behavior which would endanger the health, safety or well-being of any coach,
parent, player, participant, official or any other attendee.
4. I will not encourage my child, or any other person, to engage in any behavior which would endanger the health,
safety or well-being of any coach, parent, player, participant, official or any other attendee.
5. I will not use drugs or alcohol while at a youth sports event and will not attend, coach, officiate or participate
in a youth sports event while under the influence of drugs or alcohol.
6. I will not permit my child, or encourage any other person, to use drugs or alcohol at a youth sports event and
will not permit my child, or encourage any other person, to attend, coach, officiate or participate in a youth
sports event while under the influence of drugs or alcohol.
7. I will not engage in the use of profanity.
8. I will not encourage my child, or any other person, to engage in the use of profanity.
9. I will treat any coach, parent, player, participant, official or any other attendee with respect regardless of race,
creed, color, national origin, sex, sexual orientation or ability.
10. I will encourage my child to treat any coach, parent, player, participant, official or any other attendee
with respect regardless of race, creed, color, national origin, sex, sexual orientation or ability.
11. I will not engage in verbal or physical threats or abuse aimed at any coach, parent, player, participant, official
or any other attendee.
12. I will not encourage my child, or any other person, to engage in verbal or physical threats or abuse aimed at any
coach, parent, player, participant, official or any other attendee.
13. I will not initiate a fight or scuffle with any coach, parent, player, participant, official or any other attendee.
14. I will not encourage my child, or any other person, to initiate a fight or scuffle with any coach, parent, player,
participant, official or any other attendee.
I hereby agree that if I fail to conform my conduct to the foregoing while attending, coaching, officiating or
participating in a youth sports event I will be subject to disciplinary action, including but not limited to the
following in any order or combination:
1. Verbal warning issued by a league, organization or school official.
2. Written warning issued by a league, organization or school official.
3. Suspension or immediate ejection from a youth sports event issued by a league, organization or school official
who is authorized to issue such suspension or ejection by a school board or youth sports organization.
4. Suspension from multiple youth sports events issued by a league, organization or school official who is authorized
to issue such suspension by a school board or youth sports organization.
5. Season suspension or multiple season suspension issued by a school board or youth sports organization.

ANY VERBAL OR PHYSICAL ALTERCATIONS OF ADULTS WILL RESULT IN AN IMMEDIATE SEASON SUSPENSION OF COACHING AND OBSERVING THEIR CHILDS GAMES. ANY CHILD INVOLVED WITH THIS TYPE OF BEHAVIOR IS SUBJECT TO THE SAME PENALTY. THIS ALSO INCLUDES SOCIAL MEDIA, EMAILS OR ANY OCCURRENCE THAT IS DEEMED UNACCEPTABLE BY LSG/PINELANDS BASKETBALL. ANY FORM OF SEXUAL HARASSMENT OR MISCONDUCT WILL ALSO FALL UNDER THESE GUIDELINES. A DECISION INVOLVING ANY VIOLATION OF THE ABOVE STATED GUIDELINES WILL BE INVESTIGATED AND A DECISION VOTED ON BY THE PINELANDS BASKETBALL ASSOCIATION BOARD WITHIN 72 HOURS.THE PARTICIPANT WILL THEN BE NOTIFIED OF THE DECISION EITHER ELECTRONICALLY OR VERBALLY.

I ACKNOWLEDGE THAT I HAVE READ AND WILL COMPLY WITH THE PINELANDS BASKETBALL ASSOCIATION CODE OF CONDUCT FOR PARENTS. I UNDERSTAND THAT FAILURE TO COMPLY WITH THE CODE OF CONDUCT MAY RESULT IN THE PENALTIES SET FORTH AS LISTED ABOVE BY THE NJ MODEL ATHLETIC CODE OF CONDUCT .


I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

I have read and agree to all terms and conditions aboveParent or Guardian Initials for Consent