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Board of Directors
Flour Bluff Unit
Greenwood School Year
London School Year
Flour Bluff School Year
Flag Football League
Lights On Afterschool
Day of Giving
Community: at HOME
Club Members: MyFuture
Alumni & Friends
For more information call
Sports League Registration
Sports League Informa
Indicates required field
Coed Basketball Camp (ages 13-18)
Youth's Jersey/Shirt Size
Do not disclose
Youth's Date of Birth (MM/DD/YYYY)
Youth's School Name
Youth's School Grade
Primary Contact Information
Primary Contact's Name
Primary Contact's Relationship to Youth
Primary Contact's Phone Number
Primary Contact's Email Address
Primary Contact's Physical Address
Emergency Contact Information
Emergency Contact's Name (Other Than Primary Contact)
Emergency Contact's Relationship to Youth
Emergency Contact's Phone Number
Emergency Contact's Email Address
BGCCB is a 501(c)(3) non-profit organization. The following information is necessary for our records and the funding our organization receives. The answers you provide are kept completely confidential.
Black, African American
Native Hawaiian/Pacific Islander
American Indian/Alaska Native
Does the youth participate in the school lunch program
Does youth live in a single-parent household?
What is your annual household income
$63,000 and up
Known Health Concerns
Please list any health concerns BGCCB needs to be aware of during games & practices (i.e. asthma, heart conditions, etc.)
Known health concerns (N/A if not applicable)
I approve of my child’s application for membership and/or participation in Boys & Girls Clubs of the Coastal Bend (BGCCB) sports leagues. I will not hold the members of the Board, staff or leaders responsible for injury, which may occur while participating in the BGCCB activity mentioned above. I understand that I am responsible for transporting my child to and from events. I also acknowledge that medical insurance is not provided through BGCCB.
Players who have unpaid balance from previous BGC leagues will not be allowed to play until payment is made in full.
2. Sports League f
ees are NON-REFUNDABLE due to equipment cost, uniforms, Referees, and administrative fees.
3. BGCCB has a NO REFUND policy.
Electronic Signature (Sport League Registration)
PARTICIPANT RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that:
The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLI-GENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately, and
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Boys & Girls Clubs of the Coastal Bend, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
GENERAL MEDIA & PHOTOGRAPHIC RELEASE
The Boys & Girls Clubs of the Coastal Bend as well as Boys & Girls Clubs of America frequently use photographs information from surveys, and quotes from the members to publicize programs. Your permission is needed to use photos, testimonies, and videos, including information from surveys and/or quotes of your child(ren) on our web site (www.bgccb.org) in informational brochures, social medina and in news articles. I give my consent for any photographs or reproductions thereof (while he/she is engaged in Club-related activities) and in which my child(ren) appear or quotes my child(ren) give to be used in anyway the Club may choose including grant/publicity/fundraising purposes
General Media & Photographic Release
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE
(UNDER AGE 18 AT TIME OR REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liability incidents to my minor child's involvement or participation in these programs as provided above. EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
The Boys & Girls Club of The Coastal Bend athletics programs provide boys and girls of all ages, regardless of their athletic ability, the opportunity to learn new skills and develop self-esteem, teamwork and leadership skills. Sports programs emphasize fun and full participation for every youth. Coaches and spectators are expected to demonstrate good sportsmanship and positive support for all players and officials.
Electronic Signature (Release of Liability)
Code of Conduct
No coach, player or spectator may approach the referee or gym staff before, during, or after the game in an aggressive or abusive manner, verbally, or physically.
The first violation
will result in
a written warning and possible suspension from the next scheduled game.
The second violation
will result in
dismissal from his/her coaching/player duties.
If a player/coach is ejected from the game, he/she will be suspended for the next game and may be subject to further disciplinary action.
The player must serve his/her one (1) game suspension by
on the bench with teammates for the entire game.
In the event that a coach’s behavior contradicts the purpose of the league, (to teach basics of basketball as well as
exemplify a positive role model
) the coach will be dismissed from his/her coach’s duties.
No coach, player, or spectator shall:
Disrespectfully address or physically confront an official or Club Staff.
Attempt to influence an official’s decision
Disrespectfully address or bait an opponent, coach, player or Club staff
Object to an official’s decision by rising from the bench or using gestures
Incite undesirable crowd reactions
Yell at or mistreat a player, referee, another coach, parent or Club staff
Coaches will always wear their
shirt while coaching.
Electronic Signature (Code of Conduct)
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.
Boys & Girls Clubs of The Coastal Bend, Inc. (Club) has put in place preventative measures to reduce the spread of COVID-19; however, the Club
that you and/or your child(ren) will not become infected with COVID-19. Further,
attending the Club and/or participating in Club sports leagues could
your risk and/or 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/or I may be exposed to or infected by COVID-19 by participating in any Club programs 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 Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of 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 and/or my child(ren) may experience or incur in connection with mine and/or my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and/or on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless the Club, 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 Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.
Electronic Signature (COVID-19 Release)
By pressing submit, you are stating that you have completed and acknowledged the following documents: Sports League Registration, Code of Conduct, and COVID-19 Release.
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