Men's Adult Basketball League Team Registration Form
Men's Adult Basketball League Team Registration Form
NAME
PHONE
AGE
YMCA MEMBER?
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Return this form with payment to the Reuter Family YMCA Member Services desk by September 24th, 2012
I hereby, for myself, my heirs, executors, and administrators, waive and release any and all claims and damages I may have
against the YMCA of Western North Carolina and their respective agents, representatives, successor, and assigns, for any
and all injuries which may be suffered by me or my family in connection with participation in YMCA activities and programs.
I also grant full permission to the YMCA to use any photographs or video recordings taken of me or my family. I agree to
comply with YMCA policies and procedures and understand that my participation can be terminated without refund for
exhibiting inappropriate behavior or abuse toward the YMCA staff and/ or facilities.
Team Captain
Date
Please contact Joseph Hart Sports Coordinator: [email protected]