YMCA OF Memphis & ONE ACCORD International Teen Night Registration Form

YMCA OF MempHIS & ONE Accord International Teen Night Registration Form
Please submit the below details to allow your youth to participate in YMCA Teen Night activities at One Accord International.
Parent/ Guardian Information
Parent Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Birthdate

MonthDayYear
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Child Information

Enter Multiple participant details by selecting Add more Children.
Participant Details

Emergency Information
Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation to Child(ren)
General Waiver & Liability
The YMCA of Memphis and the Mid-South and One Accord International will not assume responsibility for any injury incurred while participating in any athletic event, sports program, or any physically related activity. Nor will the YMCA of Memphis and the Mid-South and One Accord International be liable for lost or stolen items while program participants are using One Accord facilities or are on the One Accord premises.

I, the undersigned for myself, my heirs and assigns do hereby release the YMCA of Memphis and the Mid-South/ One Accord International , its employees and agents from any and all claims for injury, death, loss or damage I may suffer as a result of my participation. I also assume full responsibility for removing myself from any media opportunities that I do not wish to participate in. To help enhance the safety of the members, guests and staff in our facilities, the YMCA monitors the National Registry of Convicted Sex Offenders. I understand that persons identified on the national registry will not be eligible for membership, guest access or program participation with the YMCA of Memphis & the Mid-South.

I also agree to adhere to the YMCA Code of Conduct. I authorize the YMCA of Memphis & the Mid-South to send text messages to my cell phone to convey information regarding activities in which I and/or my children or guests are enrolled, attending, or involved. I understand that standard text messaging rates may apply to any message received from the YMCA, and I also agree to not hold the YMCA liable for any charges or fees generated by this service, or for damages associated with the receipt of or failure to receive a text, and I understand this text message program is provided as a service to me in order for the Y to provide information to me at their discretion. I further agree that in the event my cell phone number changes, I will inform the YMCA in writing.
Signature
Date

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

YMCA OF MempHIS & ONE Accord International Teen Night Registration Form

Parent/ Guardian Information

Child Information

Emergency Information

General Waiver & Liability