Crush Childhood Cancer Fun Run & 5k Child Watch
In Partnership with the Morris Community YMCA
Participants Name (Please Complete One Form Per Child)
Participants Date Of Birth
Emergency Contact (Parent/Guardian)
Emergency Contact (Parent/Guardian) Email
Emergency Contact (Parent/Guardian) Phone Number
Please enter a valid phone number.
Emergency Contact Relationship to Child
What will your child be participating in?
Childcare During 5k (ages 2 and up)
Fun Run & Childcare During 5k (ages 2 and up)
I have read & understand the policies listed below: I certify the applicant is capable of participating in this program. I understand that YMCA Staff are trained in the basics of first aid and CPR and give consent to have my child receive first aid from YMCA Staff. I authorize the Greater Joliet Area YMCA to secure emergency medical treatment for my child, if necessary, provided that every effort to reach me is made as the nature of the emergency permits. I accept responsibility for any/all expenses incurred in securing emergency treatment for my child. I also agree to waive any claims against the YMCA, its members, staff, and volunteers for injuries or damages that may result from the conduct from other persons including participants in YMCA Programs. I understand the YMCA does not cover health and medical expenses and I agree to pay any that may occur.I give consent to those listed above to act on my behalf in an emergency in the event that I cannot be reached. I understand that YMCA Staff and Volunteers, including coaches, are not allowed to transport or babysit children at any time outside of the YMCA Program. The YMCA will take immediate disciplinary action toward staff and volunteers if a violation is discovered.I give permission to photocopy all forms. I also give my permission to the YMCA to use all photos, videos, voice, and images taken of the applicant for purposes, which the YMCA may deem appropriate. I understand that I am responsible for following the policies and procedures outlined in the specific program guidelines including parent manuals when one exists.I understand that a Facility or Community Membership is required for participation in all YMCA programs, and that all participants must maintain an active membership in good standing throughout the duration of the program. If I fail to meet my obligation to the program policies, the YMCA reserves the right to suspend my child(ren)'s participation in the program.I understand YMCA Staff is mandated by state law to report any suspected cases of child abuse or neglect to the appropriate authorities for investigation.I understand the YMCA is not responsible for lost, damaged, or stolen articles.I understand program fees are NOT refundable. Classes missed due to weather, holidays, acts of God, choice of party, or disruptive behavior cannot be made up, credited or refunded. (See the program brochure for the complete refund policy).
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