Fair Acres Family YMCA Swim Team

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					                         Fair Acres Family YMCA Swim Team
                                      Cattracks

We are excited to start the next season of Cattracks. Swim Team participants must be
able to swim the length of the pool (25 yards) Swim Testing will be available to
determine if your swimmer is ready and proper group placement.

Swim testing dates: September 6, 2012 at 6:00 and September 8, 2012 at 9:00.

Today’s date: __/__/__

Participant’s Name___________________________Age_______dob________M__F___
Swim team experience_____________________________________________________
Participant’s Name___________________________Age_______dob________M__F___
Swim team experience_____________________________________________________
Participant’s Name___________________________Age_______dob________M__F___
Swim team experience_____________________________________________________
Participant’s Name___________________________Age_______dob________M__F___
Swim team experience_____________________________________________________
Parent/Guardian Name (responsible Party)_____________________________________
Address_________________________________________________________________
Home Phone_______________Work_________________Cell_____________________
Email Address____________________________________________________________
YMCA Membership: yes____no____Membership #______________________________
School:____________________________Place of Employment____________________
Emergency Contact information:
________________________________________________________________________
________________________________________________________________________
Pg.2
Note: Contains a release and waiver of liability.

          I understand and am aware that my child will/may be participating in physical activities and that
the potential for accidents does exist. In consideration for being allowed to participate in the YMCA’s
program, I agree to assume the risk of such exercise and further agree to defend and hold harmless the Fair
Acres Family YMCA, it branches, and its staff conducting this YMCA program from any and all claims,
suits, losses, or related causes of action for damages, including (but not limited to) such claims that may
result from injury or death (accidental or otherwise) during, or arising in any way from the program. I also
understand that the Fair Acres Family YMCA may use, for publicity and/or promotional purposes, my (or
my child’s) name or pictures participating in this program, without obligation or liability to me or my
family.

         I have verified that the information on this form is up to date, and I will keep the team updated
with any changes hereafter.

         I understand that the registration must be completed with the YMCA and all outstanding fees must
be paid before my child begins practicing with the team. I understand that failure to submit the necessary
monies, as outlined on the registration form, may result in my child being withheld from participation at
practices and/or swim meets until outstanding balances are paid.

       I will support the YMCA mission, team mission, and all team policies as outlined in the Team
Handbook. I will be cooperative with the coaching staff and patient and encouraging with my child.

         I will stay informed of team events and schedules by checking my email and the website on a
regular basis. If I do not have internet access I will inform the coach that any form of electronic
communication can be printed and sent home with my swimmer.


Parent/Guardian Signature____________________________________________
Date_____________
MEDIA Release
I give permission to the YMCA to use all photos, videos, and images of my child both in print and on the
internet for the purposes of promoting YMCA programs and services, including, but not limited to the
Cattracks swim team. I give permission to the YMCA to use information on my child that they deem
appropriate for articles, newsletters, brochures, displays, the website, or other media outlets. This may be
done by the YMCA or an outside group that the YMCA has agreed to work with for the publicity of their
programs.

Parent/Guardian Signature___________________________________________________________

Date______________

				
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posted:8/29/2012
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