Pickleball Registration
This form must be submitted and payment received before a door code will be created.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Male
Female
Prefer not to say
Date of Birth
*
Is another member of your household also joining?
*
Yes
No
Additional Member Name
First Name
Last Name
Additional Member Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Member
*
Terms of Use
Please read and agree to the following for access to the Boys & Girls Club facility.
I understand this is a shared space and I will respect others property and follow all rules posted.
*
I agree
I disagree
I understand the Boys & Girls Club has the right to adjust available play hours as needed not to interfere with their primary mission.
*
I agree
I disagree
I understand that I am responsible for my monthly membership fee until at which time I formally cancel my membership, as well as all guest or reservation fees. I understand there are no refunds of membership fees.
*
I agree
I disagree
I understand my door access code is unique to me. I will not give it out to anyone.
*
I agree
I disagree
Participant Waiver
In Consideration of being permitted use of the facility for exercise, athletic endeavors or other activities at the Boys & Girls Club of Harrison County, the undersigned participant, agrees that the Boys & Girls Clubs of Harrison- Crawford Counties, its staff and all other parties, SHALL NOT BE HELD LIABLE for injury or death to the undersigned participant, or for any loss due to theft of or damage to their property or any other consequential incidental damages caused in any manner whatsoever where any such liability is attributable to the absence of ordinary or even slight care by the Boys & Girls Clubs of Harrison-Crawford Counties, in the conduct of athletic endeavors. This release, assumption of risk, and waiver shall be constructed under the laws of the state in which athletic endeavors occurred. SIGNATURE BELOW VERIFIES THAT THE UNDERSIGNED HAS READ AND FULLY UNDERSTANDS THE FORGOING AND FURTHER CERTIFIES THAT THE INFORMATION PROVIDED ON HIS/HER REGISTRATION IS TRUE AND COMPLETE.
Signature
*
Submit
Should be Empty: