Program Registration Form

7-9 yr. old Co-ed Youth Basketball

10-12 yr. old Co-ed Youth Basketball

If yes, fill out a coach's background check located on our webpage at www.jaspercountysc.gov.

Liability & Release Statement

I, the undersigned parent / guardian of the below listed child do hereby give my permission for his / her participation in the Jasper County Parks and Recreation Department 2025 youth basketball program. I am aware of the nature and extent of the program and do hereby unconditionally release and agree to hold harmless Jasper County Parks and Recreation, its volunteers, and employees from all claims of any kind or nature which may arise in connection with this program. I also give the coaches, staff of Jasper County Parks and Recreation Department, volunteers and persons acting on behalf of Jasper County Parks and Recreation Department permission to seek medical attention for my child in my absence.

Image Release

I, the undersigned parent / guardian of the below listed child do hereby.

Agree that my minor child / ward while participating in the Jasper County Parks and Recreation Department 2025 youth basketball program may be photographed or videotaped and that such image may be published in an outlet used to promote or publicize the youth basketball program. (i.e.- local newspaper, Facebook, County website)

• COMPLETE REGISTRATION ONLINE WWW.JASPERCOUNTYSC.GOV
• BIRTH CERTIFICATE (COPY)
• PAY REGISTRATION FEE

CASH OR MONEY ORDER $40

*CASH EXACT AMOUNT ONLY. NO CHANGE WILL BE GIVEN.

MAKE MONEY ORDERS PAYABLE TO:

JASPER COUNTY PARKS AND RECREATION

1458 RED DAM RD. HARDEEVILLE, SC 29927

**PAYMENT CAN BE MAILED IN OR DROPPED OFF AT SERGEANT JASPER PARK

1458 RED DAM RD. HARDEEVILLE, SC 29927

DEADLINE: Registration is closed