Youth Basketball Registration Form

The City Of Riviera Beach Youth Basketball Registration Form
Please complete all required fields*
Annual Physical

Cancelof
Birth Certificate

Cancelof
Participant Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Residence
Gender
T-Shirt/Jersey Size
Parent/Guardian Name

First NameLast Name
Relation
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternative Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent Email
example@example.com
Insurance Card

Please upload the front of insurance card
Cancelof
Proof of Residence

Proof of Residency (Utility Bill, Cell Phone Bill, etc.)
Cancelof
Emergency Contact

First NameLast Name
Relation
Emergency Contact Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email
example@example.com
Parental/Guardian Consent
Media Release Waiver: I hereby grant permission to the City of Riviera Beach Parks & Recreation Department to use photographs, video recordings, or other media of myself or my child(ren) taken during participation in the recreation program(s). These may be used for promotional purposes including, but not limited to, brochures, social media, or the City's website, without compensation.
Participant Initials:
Transportation Waiver: I hereby give permission for the City of Riviera Beach Parks & Recreation Department to provide transportation for myself or my child(ren) to and from program activities as needed. I understand that the City, its employees, and any third-party transportation providers shall not be held liable for any incidents, accidents, or injuries that may occur during transportation to or from activities.
Participant Initials:
Waiver and Consent: I, the undersigned, hereby release and hold harmless the City of Riviera Beach, a municipal corporation, its officers, agents, and employees from any and all liability, claims, demands, and causes of action arising from participation in the Parks & Recreation Department program(s). I also authorize the staff to secure emergency medical services for the participant when deemed necessary.
Participant Initials:
Register and pay for all youth and adult classes/activities can be made in person at the Parks and Recreation Department located at 2409 Ave H West. Register Early due to limited space!

It is mandatory to submit copies of: birth certificate, annual physical (must be current), proof of health insurance and utility bill (Residents of Riviera Beach ONLY) as required by the programs you register for.

Registration Payment can be made by: CASH, MONEY ORDER, or CREDIT CARD – NO CHECKS.

Please make money orders payable to the City of Riviera Beach.

Form must be completed in its entirety; all information is required at time of registration. Incomplete registration forms will not be accepted

REFUND POLICY:

Administration fee before season starts is $15.00 or 15% whichever is less

0% Credit or refund after 2nd class

Full Refund will be issued if class is cancelled.

No Refund will be issued if notified after the session has begun. (All Programs)

REFUND: Please allow 30 days to receive refund in mail.

Must return original receipt to 2409 Ave H West.

Must have mailing address and a contact number on back of receipt.

NOTE: By signing this form you acknowledge and agree the terms and conditions of the document.

CITY OF RIVIERA BEACH - PARKS AND RECREATION

2409 Ave H West, Riviera Beach, FL 33404

Phone: (561) 845-4070 Email: Parks@rivierabeach.org

Office Hours: Monday - Friday: 8:30 AM to 5:00 PM
Youth Basketball Payment
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Youth Basketball Registration 70008
Payment for The City Of Riviera Beach Youth Basketball League 2025.

70008

$60.00 Youth Basketball Registration 70008

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

The City Of Riviera Beach Youth Basketball Registration Form

Please complete all required fields*

Parental/Guardian Consent

Youth Basketball Payment

Payment Methods