Middle School Basketball Program

PISCATAWAY RECREATION DEPARTMENT

Registration Form

Edit Form

Program Name

Please fill in the form below.

Participant Info

Participant First Name*

Participant Last Name*

Does participant have any special/medical needs?* No Yes

If Yes, please list the special needs

Grade* 5 6 7 8

Address:*

Parent/Guardian Info

Parent/Guardian First Name*

Parent/Guardian Last Name*

Cell Phone (AAA-CCC-XXXX)*

Email Address*

Emergency Contact Info (CANNOT BE A PARENT/GUARDIAN)

Emergency Contact First Name*

Emergency Contact Last Name*

Phone Type* Cell Home Work

Phone (AAA-CCC-XXXX)*

Does participant have any siblings trying out for this program this year?* Yes No

Sibling Name(s)

You must “type” your name in the signature box in lieu of your actual signature and validate with today's date in the box below. By doing so you are authorizing Piscataway Recreation Department to accept this mark as your official authorized signature.

Parent/Guardian Signature*

Electronic Signature Verification*

By selecting today's date you are authorizing Piscataway Recreation to use this entry as your authorized "electronic signature". You are also agreeing to act within the guidelines set by the Code of Conduct listed above. Participants in the Piscataway Recreation sponsored events do so at their own risk and accept full responsibility for all their actions and injuries incurred by their participation. Prior to submitting a claim to the Township, injured parties must first use their own medical/accident insurance as their primary coverage. The insurance offered by Piscataway Township is supplemental and secondary only. If a claim qualifies for consideration, the Township insurance is limited to a maximum payout of no more than $5,000.00 per accident.

 


Piscataway Code of Conduct

Youth Sports Programs play a very important role in the promotion of the physical, social, and emotional development of children. It is therefore essential for parents, coaches, officials and spectators to encourage youth sports participants to embrace the values of good sportsmanship. Moreover, adults involved in youth sports events should be models of good sportsmanship and should lead by example by demonstrating fairness, respect and self-control.

In accordance with this mission, the Piscataway Township Council has adopted a Model Code of Conduct ordinance for Piscataway Recreation programs as well as Little League and Soccer Club programs. Township Ordinance 03-41 is in accordance with New Jersey Public Law 2002, Chapter 74.

Parents and legal guardians of Piscataway Recreation youth participants are required to read and sign this Model Code of Conduct on behalf of themselves and their children.  This document must be submitted to the Recreation Office at the time of program registration.
Children cannot be registered or begin program participation without submitting a fully completed and signed Registration/Code of Conduct form.

STATE OF NEW JERSEY

Model Athletic Code of Conduct

The following model athletic code of conduct is promulgated in accordance with the provisions of P.L. 2002, Chapter 74.
Preamble:

Interscholastic and youth sports programs play an important role in promoting the physical, social and emotional development of children. It is therefore essential for parents, coaches and officials to encourage youth athletes to embrace the values of good sportsmanship. Moreover, adults involved in youth sports events should be models of good sportsmanship and should lead by example by demonstrating fairness, respect and self-control.

I therefore pledge to be responsible for my words and actions while attending, coaching, officiating or participating in a youth sports event and shall conform my behavior to the following code of conduct:

1. I will not engage in unsportsmanlike conduct with any coach, parent, player, participant, official or any other attendee.
2. I will not encourage my child, or any other person, to engage in unsportsmanlike conduct with any coach, parent, player, participant, official or any other attendee.
3. I will not engage in any behavior which would endanger the health, safety or well-being of any coach, parent, player, participant, official or any other attendee.
4. I will not encourage my child, or any other person, to engage in any behavior which would endanger the health, safety or well-being of any coach, parent, player, participant, official or any other attendee.
5. I will not use drugs or alcohol while at a youth sports event and will not attend, coach, officiate or participate in a youth sports event while under the influence of drugs or alcohol.
6. I will not permit my child, or encourage any other person, to use drugs or alcohol at a youth sports event and will not permit my child, or encourage any other person, to attend, coach, officiate or participate in a youth sports event while under the influence of drugs or alcohol.
7. I will not engage in the use of profanity.
8. I will not encourage my child, or any other person, to engage in the use of profanity.
9. I will treat any coach, parent, player, participant, official or any other attendee with respect regardless of race, creed, color, national origin, sex, sexual orientation or ability.
10. I will encourage my child to treat any coach, parent, player, participant, official or any other attendee with respect regardless of race, creed, color, national origin, sex, sexual orientation or ability.
11. I will not engage in verbal or physical threats or abuse aimed at any coach, parent, player, participant, official or any other attendee.
12. I will not encourage my child, or any other person, to engage in verbal or physical threats or abuse aimed at any coach, parent, player, participant, official or any other attendee.
13. I will not initiate a fight or scuffle with any coach, parent, player, participant, official or any other attendee.
14. I will not encourage my child, or any other person, to initiate a fight or scuffle with any coach, parent, player, participant, official or any other attendee.

I hereby agree that if I fail to conform my conduct to the foregoing while attending, coaching, officiating or participating in a youth sports event I will be subject to disciplinary action, including but not limited to the following in any order or combination:

1. Verbal warning issued by a league, organization or school official.
2. Written warning issued by a league, organization or school official.
3. Suspension or immediate ejection from a youth sports event issued by a league, organization or school official who is authorized to issue such suspension or ejection by a school board or youth sports organization.
4. Suspension from multiple youth sports events issued by a league, organization or school official who is authorized to issue such suspension by a school board or youth sports organization.
5. Season suspension or multiple season suspension issued by a school board or youth sports organization.