Youth Program Registration

Child's Name: Birth Date: Age:

School: Grade: Gender: Male Female

Address: City: State: Zip:

Parent's Name: Phone:

Email Address:

I would like to volunteer coach: No Yes

Emergency Contact: Phone:

Program: Itty Bitty Youth Sports Eastside Sports

League (if applicable): Select Yakima West Valley

T-Shirt Size: Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large

I would like my child to be on a team with (optional):

I hereby consent to participation of my child in the Yakima Family YMCA program indicated above. I also, on behalf of my child, agree to indemnify and hold harmless the Yakima Family YMCA from any claims, costs, damages, liabilities or expenses resulting form injury to my child while in the care, custody or company of the directors or staff members. I also give permission for the Yakima Family YMCA to use any photographs or videos of my child for promotional purposes.