Fillable Birthday Party Registration Form - Ymca printable pdf download

BIRTHDAY PARTY

REGISTRATION FORM

Parent/Guardian Information:

Last Name:

First:

Phone:

Address:

City:

ST:

Zip:

Email address:

Birthday Child’s Information:

Name:

Age:

Shirt Size

Medical Conditions:

Date of party:

# of children attending

# of adults attending:

PLEASE MARK CHOICES:

Party Time:

Friday, 6:30-8pm

Saturday, 12-1:30pm

Saturday, 2-3:30pm

Sunday, 2-3:30pm

__________

Party Package:

Member: Tumble Party

Non-Member: Tumble Party

(1-8 years of age)

Member: Rock Climbing Party

Non-Member: Rock Climbing Party

(7-12 years of age)

Member: Pool Party

Non-Member: Pool Party

(8-12 years of age)

Color choice for table:

_______Blue

_______Green

_______Yellow

_______Red

_______Pink

Waiver / Consent Form: Please Read and Sign

In consideration for participating in Billings Family YMCA Activities, I hereby release, waive, discharge and hold harmless Billings Family YMCA, their officers,

agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out

of, or related to any loss, damage, or injury that may be sustained by me, my children, or to any property belonging to me, regardless of the cause; including

negligence, while participating in such activity, or while upon the premises where the activity is being conducted or in transportation to and from said

premises.

I certify that I or my children’s present level of physical condition is consistent with the demands of active participation. I am fully aware of risks and hazards

connected with YMCA activities, including daily program transportation, YMCA field trips, swimming, emergency medical care, authorized dispensing of

prescription medications and I hereby elect to voluntarily participate or to have my children participate in said activity and assume the risks associated with

the activity.

I further hereby agree to indemnify and hold harmless RELEASEES from any loss, liability, damage or costs, including court costs and attorney’s fees, that may

be incurred due to my participation or my children’s participation in said activity, whether caused by negligence of RELEASEES or otherwise.

I understand that the Billings Family YMCA will not be responsible for any medical costs associated with an injury I or my children may sustain. As a parent

and/or guardian, I authorize the treatment of participants as deemed necessary by medical professionals in the event of a medical emergency.

I further agree to become familiar with the rules and regulations of the Billings Family YMCA concerning my conduct or the conduct of my children and not to

violate said rules of any directive or instruction made by the person or persons in charge of said activity. I will further assume the complete risk of any

activity done by me or my children in violation of any rule, directive, or instruction.

I understand that payment for programs or services is due prior to the start of the program. Should a bank return an EFT or check for insufficient funds, I will

be charged a fee of $25 per occurrence. The YMCA reserves the right to issue credit or refunds at its discretion in the event of program cancellation or as

special circumstances arise. Approved refunds will be assessed a $10 processing fee prior to being refunded.

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