YMCA Sports Complex Participation Waiver

YMCA Sports Complex Participation Waiver

Event Date: 04/25/25
Participant Name

First NameLast Name
DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Waiver: In consideration of my [and/or my child(s)] participation in this activity, I hereby release and discharge the YMCA of the Chippewa Valley, and its representatives, successors, and assigns, from any and all liability arising from accident, injury, and illness that I (he/she) may suffer as a result of my (our) participation in this activity. I acknowledge that all activities involve the potential risk of accident, injury or illness. I (we) also will follow the rules and regulations set by the Organization and above-named parties. Parent or guardian must sign for anyone age 17 and under.

I do hereby grant and give these groups the right to use my or my child(s) photograph or image with or without my or my child’s name, both singly and in conjunction with other persons or objects and presentations, advertising, publicity, and promotion relating thereto.
Participant Signature (Guardian Signature if participant is a Minor)
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: