New Athlete Application

This application form is to be completed by a legal parent or guardian so that your daughter may be considered for membership to the Space Coast Girls Basketball Club in order to participate in club activities.

Applicant Information

Applicant Applicant Policy

Applicant Name

First

Last

Applicant Email

Applicant Phone

Applicant School

Applicant Grade

Applicant Basketball Experience Level

Medical Conditions and Allergies

Add any conditions or allergies this athlete has. Use the + to add additional conditions or allergies.

Condition/Allergy

Medical Insurance Provider

Medical Insurance Policy Number

Parent/Legal Guardian Information

Parent/Legal Guardian Name

First

Last

Parent/Legal Guardian Email

Parent/Legal Guardian Phone

I certify that I am the legal parent or guardian of the applicant. I understand that if the athlete is accepted into the Space Coast Basketball Club, membership will require both my agreement and the athlete’s agreement to the terms outlined below. *

1. Purpose & Nature of Club

– Space Coast Basketball Club [“the club”] aims to promote enjoyment of basketball, develop athletic and personal skills, and provide mentorship and volunteer opportunities for youth and young adults in a positive, fun, and engaging environment.
– Space Coast Basketball Club is a voluntary, recreational scrimmage group for learning, practice, improvement, and enjoyment.
– Space Coast Basketball Club operates as a not-for-profit, volunteer-led organization. Any funding raised, donated, or collected through team fees or dues will be used solely for the operation of the club. Funds collected in excess of the club’s operational costs are donated to our selected beneficiary, the Girls Basketball program at Edgewood Jr/Sr High School.
– Activities held during Space Coast Basketball Club events may include informal games, drills, practices, and friendly intraclub competitive scrimmages with mixed skill levels with no formal referees or officials.

2. Code of Conduct

– Players, coaches, parents/guardians, spectators, and all others associated with Space Coast Basketball Club will demonstrate respect, sportsmanship, and safe behavior at all times.
– Fighting, unsafe play, or disrespect of others may result in removal from the club without refund.

3. Assumption of Risk

– Basketball involves inherent risks of injury, including but not limited to falls, collisions, sprains, broken bones, heat exhaustion, and other risks associated with vigorous physical activity.
– By participating, I voluntarily assume all risks associated with club activities, including practices, scrimmages, travel, and related events.

4. Waiver & Release of Liability

– In consideration of being allowed to participate, I release, discharge, and hold harmless Space Coast Basketball Club, its organizers, coaches, volunteers, facility partners, and affiliates from any and all liability, claims, or damages arising from participation, except in cases of gross negligence or intentional misconduct.
– I understand that Space Coast Basketball Club maintains a general liability insurance policy through Player’s Health Cover USA Inc., but this coverage does not eliminate the risks of injury associated with participation. I acknowledge that the policy primarily protects the organization and does not guarantee coverage for individual medical expenses, which remain my responsibility.

5. Medical Authorization

– I understand that Space Coast Basketball Club does not provide health or accident insurance. All medical expenses are my responsibility.
– I authorize Space Coast Basketball Club staff or volunteers to seek emergency medical care for myself/my child if I cannot be reached.
– I consent to treatment deemed necessary by licensed medical personnel.

6. Photo/Video Release

– I grant permission to Space Coast Basketball Club to use photographs, video recordings, and likenesses of my child for promotional, educational, and marketing purposes, in print or digital media, without compensation.

Parent Legal Guardian eSignature

By typing your name above, you consent to use an electronic signature in accordance with the U.S. ESIGN Act. Your typed name will serve as your legal signature, confirming your intent to sign and your agreement to the club’s terms and conditions. You also agree to conduct this transaction electronically and acknowledge that this record may be retained in electronic form.