Pride Celebration

2023 PRIDE CELEBRATION

Thursday, June 08, 3:30-6:00 PM | Berkeley Heights Community Pool at the YMCA
A parent/guardian is required to complete and sign the application for minors under the age of 18.
Is the attendee 18 years of age or older?

YesNo
GUEST INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Email*
example@example.com
Phone Number*
ex. 555-555-5555
YMCA Member Status*

Berkeley Heights YMCASummit YMCANot a member
Ethnic Origin

WhiteBlack/African AmericanNative Hawaiian/Pacific IslanderAsianAmerican Indian/Alaska NativeTwo or More RacesPrefer not to say
Please note: Y-USA requests the above information from YMCA participants throughout the nation for program funding and demographic purposes.

Parent/Guardian Information
Name*

First NameLast Name
Relationship to Minor*
Date of Birth*

MonthDayYear
Date
Phone Number*
ex. 555-555-5555
Parent/Guardian Email Address*
example@example.com
Do you want to provide Emergency Contact information that is different from the Parent/Guardian information provided above?*

YesNo

2023 PRIDE CELEBRATION