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City of Cleveland

dominique.green@cityofclevelandms.com

100 North Street, PO Box 1439, Cleveland, MS, 38732, US

662-846-1471

CLEVELAND PARK COMMISSION

BASKETBALL REGISTRATION FORM

Child's Name (#1)

Child's Sex

Birthday

Other Information

Full Address

Shirt Size

If you do not need to register additional children, HIT NEXT.

Child's Name (#2)

Child's Sex

Birthday

Other Information

Full Address (If different from Child #1)

Shirt Size

If you do not need to register additional children, HIT NEXT.

Child's Name (#3)

Child's Sex

Birthday

Other Information

Full Address (If different from Child #1 or Child #2)

Shirt Size

Parent/Guardian Information

Parent/Guardian Information

Phone Number and Email Address

Emergency Contact Information

Are you interested in coaching a team?

Indemnification and hold Harmless Agreement

Whereas, the child(ren) registered per this registration form, a minor(s), will be allowed to participate in the Baseball or Softball program provided and supervised by the City of Cleveland Park Commission.  As the parent or guardian of the minor child(ren) registered per this registration form, I acknowledge and agree to the following:

NOW, THEREFORE,  FOR AND IN CONSIDERATION of the benefits and privileges extended to said minor and the undersigned by the City of Cleveland, I, the parent or legal guardian, do hereby agree to indemnify and hold harmless the City of Cleveland, Mississippi, the City of Cleveland Park Commission, their agents, sponsors, directors, officers, officials, advertisers, workers and employees, whether paid or volunteer, and any other person or persons involved with the event from any and all claims and liabilities for any kind, character or description for damages or other losses arising out of or claimed to arise out of or by virtue of said minor’s participation in the aforesaid program. This is to include but not limited to all injuries, disabilities, loss of property or damage to person due to your child or ward’s participation.  It is understood and agreed that this Indemnification and Hold Harmless Agreement applies to all costs incurred by any person covered by the terms of this Indemnification and Hold Harmless Agreement, including cost of defense and attorney fees.  I have read this release of liability and assumption of risk, fully understand its terms, understand that I have given up substantial rights by signing it, and sign freely and voluntarily without an inducement. 

Parent's Signature

Choose how to sign

Proof of Residency

As the Park Commission is funded via taxes paid by citizens who reside within the city limits of the City of Cleveland, it is required that registrants provide proof of residency proving they reside within the city limits of the Cleveland to obtain the Cleveland resident rate of $40 per child. Persons who do not reside within the city limits of the City of Cleveland are to pay the Non-Cleveland residents rate of $80 per child.

Listed below are acceptable documents;

  • Any document issued by this State or county, city, or the federal government detailing the registrant's current address;
  • MS Vehicle Registration Card or title;
  • MS Voter Precinct Card;
  • Military Orders/Documents;
  • Utility bill or cable bill;

 

Upload at least one (1) proof of residency document.

Is your address located within the city limits of Cleveland?

Seamless Pay

City of Cleveland Resident Registration Fee (per child) 40.00
Non-Cleveland Resident Registration Fee (per child) 80.00
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Processing Fee
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