YMCA of the Chippewa Valley Parent / Child Waiver
Parent Name
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First Name
Last Name
Parent Email
*
example@example.com
Parent Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Athlete Information
Athlete Name
*
First Name
Last Name
League
Mens Soccer League
High School Soccer
Middle School Soccer
Coed Volleyball
League
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High School Volleyball
Middle School Volleyball
3v3 Boys Basketball
3v3 Girls Basketball
Middle School Girls Basketball
High School Girls Basketball
Team / Captain / Team Manager Name
*
Notes
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Parent / Child Waiver
In consideration of my and/or my child(ren)’s participation in this activity, I hereby release and discharge the YMCA of the Chippewa Valley, including its representatives, successors, and assigns, from any and all liability for any accident, injury, or illness that may occur as a result of participation in this activity. I understand and acknowledge that participation in activities involves inherent risks, including the risk of accident, injury, or illness. I agree that I and/or my child(ren) will abide by all rules and regulations established by the Organization and the parties named above. A parent or legal guardian must sign on behalf of any participant under the age of 18. I further grant permission to the YMCA of the Chippewa Valley and affiliated groups to use photographs or images of me and/or my child(ren), with or without names, individually or in conjunction with other persons or materials, for purposes including presentations, advertising, publicity, and promotional materials. I understand that teams with outstanding balances not paid in full may forfeit participation and may be removed from the program. Please note that online registration is required for all individual Play-In Fees.
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