please complete registration form and · pdf filei understand that the foregoing waiver of...

I represent to the YMCA that I and/or my child is physically fit to perform those activities which he/she may undertake with the YMCA and that I am solely

responsible for all health risks associated with such activities.

I understand that the YMCA recommends that I and/or my child be examined by a physician prior to engaging in activities with the YMCA. I acknowledge

that the YMCA, including its employees, are not licensed medical practitioners, and that their advice is therefore limited in scope and is not a substitute for

medical supervision and/or advice. I acknowledge that I and/or my child’s attendance and participation, at the YMCA (or with the YMCA off campus), in

activities and programs, including without limitation his/her use of the YMCA’s equipment and facilities, I hereby assume all risks of personal injury, death,

property loss or other damages which may result from or arise out of attendance at or use of the YMCA and or its equipment in any programs or activities

with the YMCA. I understand that the foregoing waiver of liability on my behalf shall apply to any and all claims against the YMCA, and/or its owners,

shareholders, officers, directors, employees, agents or affiliates (collectively, “YMCA Affiliates”) for any such personal injuries, property loss or other

damages connected to or arising out of any of the afore said risks.

I hereby on behalf of myself and/or my son/daughter fully and forever release and discharge the YMCA, and YMCA affiliates, from any and all claims,

damages, demands, rights of action or causes of action, present or future, known or unknown, anticipated or unanticipated, resulting from or arising out of

my and/or my child’s attendance at or use of the YMCA or their participation in any YMCA activities or programs, including those which arise out of the

negligence of the YMCA and/or its affiliates. Further, I hereby release and discharge the YMCA and its affiliates from any and all loss, or theft of, or damage

to personal property, including without limitation to automobiles and contents on host property.

Standard Form of Release

For valuable consideration, I hereby irrevocably consent to and authorize the creation, use and reproduction by the YMCA and/or its agents working on their

behalf, of any and all photographs and/or videos taken of me. All negatives and videos shall constitute YMCA property, solely and completely.

I waive the right to approve, or inspect the photographs, videos, advertising copy or printed materials in conjunction therewith. The YMCA does, however,

agree to only use such materials in context of good taste, and in compliance with usual and customary social mores.

I hereby warrant that I have read this agreement in its entirety before signing, and I fully understand its contents therein. I further warrant that I am of

legal age and competent to contract in my own name as far as the above is concerned. [PLEASE PRINT]

PARTICIPANT NAME DOB

AGE, SEX AND GRADE SCHOOL

STREET ADDRESS

CITY STATE ZIP CODE

HOME PHONE CELL PHONE

EMERGENCY CONTACT EMERGENCY PHONE

E-MAIL

GUARDIAN NAME: RELATIONSHIP

DATE SIGNATURE

• ARE YOU INTERESTED IN SERVING AS A VOLUNTEER COACH ALONGSIDE OUR INSTRUCTOR COACH DURING THIS

LEAGUE SESSION? + YES + NO IF SO, SPECIFY THE DESIRED SPORT: _______________________

• ARE YOU INTERESTED IN SPONSORING A TEAM IN ONE OF OUR YOUTH LEAGUES? + YES + NO

IF YES, PLEASE WRITE DOWN YOUR NAME, COMPANY AND A CONTACT NUMBER WHERE YOU MAY BE REACHED.

PLEASE TURN OVER AND FILL OUT THE PROGRAM INFORMATION ON THE BACK SIDE

PLEASE COMPLETE REGISTRATION FORM AND RETURN WITH PAYMENT TO FRONT DESK (SPORTS DEPT MAILBOX ONCE COMPLETED WITH ATTACHED RECEIPT):

BASKETBALL LEAGUES

� 3-4 yr old Fundamentals BB League




� 3rd & 4th Grade Competitive BB League

� 5th & 6th Grade Competitive BB League

� 7th - 9th Grade Competitive BB League

� 10th – 12th Grade Competitive BB League

� Other_______________________

LEAGUE SESSION

� Jan – March

� April – June

� July – September

� Oct – Dec

BASKETBALL PROGRAMS

� Basketball Personal Training

� Biddy B-Ballers BB Clinic (3–5 yr olds)

� BB Clinic _______________________

� BB Camp 2-Day Christmas Basketball Camp

� 2-Day Spring Break Basketball Camp

� 5-Day Summer Basketball Camp

� OTHER______________________

OTHER SPORTS

� Speed, Agility & Vertical Leap Training

� Pickleball

� DUNIGAN � DOWNTOWN

� Other ______________________

VOLLEYBALL LEAGUES

� 4th – 6th Grade Volleyball League

� 7th – 8th Grade Volleyball League

� HS JV Volleyball League (9th – 10th Grd)

� HS Varsity Volleyball (10th – 12th Grade)

� Adult Coed Volleyball League

� $10 Adult Coed Sand Volleyball League

� Other______________________

LEAGUE SESSION

� Jan – March

� April – June

� July – September

� Oct - Dec

VOLLEYBALL PROGRAMS

� Volleyball Personal Training

� Little Setters VB Clinic (1st – 3rd Grade)

� VB Clinic _______________________

� VB Camp 2-Day Christmas Volleyball Camp

� 2-Day Spring Break Volleyball Camp

� 5-Day Summer Volleyball Camp

� OTHER______________________

$10 ADULT SAND VB LEAGUES

� $10 Adult Coed Sand Volleyball League

SAND VB LEAGUE SESSION

� April 13th - May 13th

� June 1st - July 13th

� July 20th - Aug24th

� Sept 14th - Oct19th

SOCCER LEAGUES

� 3-4 yr old Fundamentals SCR LG



� 5th & 6th Grade Competitive SCR LG

� 7th - 8th Grade Competitive SCR LG

� Other______________________

LEAGUE SESSION

� April - May

� August - October

SOCCER PROGRAMS

� Soccer Personal Training

� First Kicks Soccer Clinic (3-5 yr olds)

� Soccer Clinic _____________________

� Soccer Camp 2-Day Christmas Soccer Camp

� 2-Day Spring Break Soccer Camp

� 5-Day Summer Soccer Camp

� OTHER______________________

$10 ADULT SPORTS LEAGUES

� $10 Adult 3V3 SOCCER League

� $10 Adult ULTIMATE FRISBEE League

� $10 Adult FLAG FOOTBALL League

� Other _______________________

LEAGUE SESSION

� April 13th - May 13th (no FF)

� Sept 14th - Oct19th

GYMNASTICS PROGRAM

� Parent & Tot Gymnastics

� T @ 9 a.m.

� F @ 10 a.m.

� Junior Gymnastics

� M @ 5 p.m.

� T @ 10 a.m.

� F @ 11 a.m.

� Level 1 Gymnastics

� M @ 6 p.m.

� Saturday @ 10:30 a.m.


� M @ 7 p.m.

� Saturday @ 11:30 a.m.


� Saturday @ 12:30 p.m.

� Dance

� Saturday @ 12:00 p.m.

� Tumbling (TBA)

� Cheerleading

� 3-4 yr olds

� 5-6 yr olds

� 7-8 yr olds

� 9-12 yr olds

CHEER LEAGUE SESSION

� Jan – March

� Oct - Dec

SPECIAL SPORTS EVENTS

� $10 Adult POWDER PUFF FF League

� 3-Point Shooting Contest

�

MARTIAL ARTS PROGRAM

� Little Dragons (4-6 yr olds)

� Taekwondo Level 1

� Taekwondo Level 2

� DUNIGAN � DOWNTOWN

BASETBALL/SOFTBALL LEAGUE

� INSTRUCTIONAL BASEBALL LEAGUE

3-4 yr old League

� PEE WEE T-BALL BASEBALL LEAGUE

5-6 yr old League

� MINORS SOFTBALL LEAGUE

7-8 yr old League

LEAGUE SESSION

� Aug - Oct

� April - May

BASEBALL/SOFTBALL PROGRAMS

� Baseball Personal Training

� Softball Personal Training

� Baseball/Softball Clinic _____________

� OTHER______________________

T-Ball Field Rentals

Call (812) 401-YMCA

FLAG FOOTBALL LEAGUE

� 3-4 yr old Flag Football League




LEAGUE SESSION

� Aug - Oct

please complete registration form and · pdf filei understand that the foregoing waiver of...

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