Program Registration Form


Coed Youth Basketball
Girls Youth Volleyball
Coed Youth Soccer
Youth Football ( Ridgeland Jr. Jaguars)
Youth Cheerleading ( Ridgeland Jr. Jaguars)


Male
Female

Physical Address:(No P.O. #’s or Rt. #’s)








7-9 Coed Basketball
10-12 Coed Basketball
7-9 Girls Volleyball
10-12 Girls Volleyball
4-5 Coed Soccer
6-8 Coed Soccer
9-11 Coed Soccer
12-14 Coed Soccer
7-8 Small Fry
9-10 Pee Wee
11-12 Midget
Cheerleading



YXS
YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL

Yes
No


Yes
No

Yes No

All coaches must submit to a Background Check. (consent forms located on our webpage www.jaspercountysc.gov along with coaching applications.)

Football Fee : $60 (Does not include shoulder pads)

Cheerleading Fee : $60 (Uniform Top and Bottom)

Make Checks or Money Orders Payable to:
Jasper County Parks and Recreation
1458 Red Dam Rd.
Hardeeville, SC 29927

Jasper County Parks and Recreation Department

Liability and 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 2022 selected sport. 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.


Yes




Image Release Form

Image Release Form 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 2022 sports program may be photographed or videotaped and that such image may be published in an outlet used to promote or publicize the youth program. (i.e.- local newspaper, Facebook, County website)


Yes




Jasper County Parks and Recreation Department


Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

The Jasper County Parks and Recreation Department has created new protocols and put in place preventative measures to reduce the spread of COVID-19; however, Jasper County Parks and Recreation Department cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending any program may increase your child(ren)s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Jasper County Parks and Recreation Department program, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Jasper County Parks and Recreation Department program may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Jasper County Parks and Recreation Department employees, volunteers, and program participants and their families.

I voluntarily agree to assume all the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself including, but not limited to, personal injury, disability, and death, illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)s attendance at the Jasper County Parks and Recreation Department program. On my behalf, and on behalf of my child(ren)s, I hereby release, covenant not to sue, discharge, and hold harmless Jasper County Parks and Recreation Department, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Jasper County Parks and Recreation Department, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Jasper County Parks and Recreation Department program.


Yes