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Aquatics Registration

Registration is not confirmed until payment is received. Please contact the YMCA for further processing. 50% of fee is non-refundable.

PLEASE FILL OUT FORM COMPLETELY

Child's Name:

Birth Date: Age: Gender:

Address:

City: State: Zip:

Phone: Email Address:

School/Child Care:

Parent's Name: Phone:

Class:

Time:

I hereby consent to participation of my child in the Yakima Family YMCA youth aquatics program. 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.

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