randolph-asheboro ymca

Program/sports REGISTRATION

Program Participant’s Name:                                                                 Nick Name:      

Date of birth:      

Grade:      

Phone:      

Current Address:      

City:      

State:      

Zip Code:      

School:      

New Participant:      

Male/Female?      

FAMILY CONTACT INFORMATION

Father’s Name:      

Mailing Address:      

Apt #:      

Day Phone:      

E-mail:      

Evening Phone:       

City:      

State:      

ZIP Code:      

 

Mother’s Name:      

Mailing Address:      

Apt. #:      

City:      

State:      

ZIP Code:      

Day Phone:      

E-mail:      

Evening Phone:      

T-Shirt Size

         YS (6-8)             YM (10-12)             YL (12-14)             AS              AM            AL             AXL             AXXL                                             

Shirt Size:      

 

 

sponsorships and volunteer information

Contact Name:      

Company Name if applicable:      

Phone:      

Coach?      

Assistant Coach?      

Team Parent?      

Team Sponsorship?      

Youth Fitness:      

Triathlon Sponsorship:      

Email:      

 

 

Background checks are required for all coaches and assistant coaches

MEDICAL RELEASE / Signature

1.     I hereby certify may child is in normal health and capable of safe participation in the Youth Sports Programs.  I assume all risk(s) and hazards incidental to the conduct of this program and for the transportation to and from the program.  In the event that I cannot be reached to make arrangements for emergency medical attention at the time of an illness or accident I hereby authorize the Randolph-Asheboro YMCA to transport my child to the nearest medical facility for treatment deemed necessary.

 

2.     I support the YMCA youth sports philosophy, which is based on “Athletes First, Winning second”, participation, fun, physical fitness, skill development, teamwork, fair play, family involvement, and volunteer leadership.

 

 

 

 

Signature of parent or guardian:

 

 

 

Date: