I give my permission to the Billings Family YMCA to use photographs, film footage, or tape recordings which may include my or my children’s image or voice
for purpose of promoting or interpreting YMCA programs.
In signing this release, I acknowledge and represent that I am at least eighteen (18) years of age, I have read and understand this waiver, and sign it
voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made.
It is the policy of the Billings Family YMCA to deny membership or guest access to any individual listed on any sexual and/or violent offender registry. The
Billings family YMCA will periodically check membership records for criminal history.
Parent/Guardian Signature:
Date:
Birthday Party Roster (Please list all attendees):
Childs Name____________________________________________________________ Parent Signature_________________________________________________________________
Childs Name____________________________________________________________ Parent Signature_____________________________________ ____________________________
Childs Name____________________________________________________________ Parent Signature________________________________________________________________ _
Childs Name____________________________________________________________ Parent Signature_____________________________________ ____________________________
Childs Name____________________________________________________________ Parent Signature_____________________________________ ____________________________
Childs Name____________________________________________________________ Parent Signature_________________________________________________________________
Childs Name____________________________________________________________ Parent Signature_____________________________________ ____________________________
Childs Name____________________________________________________________ Parent Signature____________________________________________ _____________________
Childs Name____________________________________________________________ Parent Signature_____________________ ____________________________________________
Childs Name____________________________________________________________ Parent Signature_____________________________________ ____________________________
Childs Name____________________________________________________________ Parent Signature_________________________________________________________________
Childs Name____________________________________________________________ Parent Signature_____________________________________ ____________________________
Childs Name____________________________________________________________ Parent Signature__________________________________________ _______________________
Childs Name____________________________________________________________ Parent Signature_________________________________________________________________
YMCA OFFICE USE ONLY
Registration Taken by:
Entered by:
Additional Participant Amount:
Taken By:
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