Slide 1

All Basketball Applications Must Have the Following When Turned In.
Copy of Birth Certificate
Proof of MS Residency ( utility bill, mortgage statement, the applicants
report card from school)
Registration Payment (Payments Accepted Cash Credit Card or Money Order)
Registration Fee before December 1st 2014
$85.00 Mississippi Residents / $100.00 Non- Mississippi Resident
Registration Fee after December 1st 2014
$100 Mississippi Resident / $120.00 Non- Mississippi Resident
Just a reminder during the Season the games will have a $3.00
entry fee at the doors (players and children 5 and younger are free).
1. Every player registering for an HLPR sports program drafted onto a team through the draft system.
(Special requests, such as playing for a certain coach, on a certain team, or with a certain team mate
will not be considered.)
2. I, The Parent/ Guardian of the named candidate for a position on an HLPR Team, hereby give my
approval for the child to participate in any and all programs or activities during the season. I assume
all risks and hazards incidental to such participation, including, but not limited to transportation to and
from activities; and I do hereby individually, and for and on behalf of the child waive, release, absolve,
Indemnify and agree to hold harmless the City of Horn Lake , it’s staff, employees, officers, Elected and
Appointed Officials, organizers, sponsors, supervisors, participates and persons transporting my child to
or from activities, from any claim for property damage, personal injury and/ or death arising out of injury
to my child or damage property.
3. I, The Parent / Guardian of the named player, understands that he/she is participating in a team sport
and the Participation Policies set forth by the Parks and Recreation Department apply to the registration
of the named player.
4.No refund after a Player or Cheerleader have been placed on a team.
5.I,The Parent/ Guardian give permission to HLPR to release to my child’s coach the necessary personal
Contact information.
*PARENT SIGNATURE ______________________________________ DATE ______________

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