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BCNC REC REUNION Volleyball Registration
PROGRAM DATES/TIMES:
SATURDAY | 2:00-5:00PM
AUGUST 3, 2019

LOCATION:
BCYF QUINCY COMMUNITY CENTER GYMNASIUM
885 WASHINGTON STREET
BOSTON CHINATOWN, MA 02111

PLEASE REGISTER IN ADVANCE BY FILLING OUT THE FORM BELOW.

QUESTIONS? PLEASE CONTACT ALLAN.ZAMORA@BOSTON.GOV OR CALL 617-635-5129, X1087
Email address *
TEAM NAME (or FREE AGENT) *
Your answer
FIRST NAME *
Your answer
LAST NAME *
Your answer
DATE OF BIRTH *
MM
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DD
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YYYY
GENDER *
EMAIL ADDRESS
Your answer
The application is factual and complete to the best of my ability. I hereby waive and release any and all rights, causes of action, and claims for damages I may have against the City of Boston, Boston Centers for Youth & Families, and any and all other associated individuals or organizations, for any and all personal injuries or property damage resulting from my participation in Boston Centers for Youth and Families Programs. I, the undersigned parent or guardian of [____________________], a minor, hereby consent to his/her Boston Centers for Youth and Families membership and waive and release any and all rights, causes of action and claims for damages I may have against the City of Boston, Boston Centers for Youth & Families, and any and all other associated individuals or organizations, arising out of any and all personal injuries or property damage which I may now or hereafter have as the parent or guardian of said minor, and also all rights, causes of action, and claims which said minor has or may acquire resulting from his/her participation in the program. I give consent for me/my child to be administered first aid and to be treated by an emergency medical technician-paramedic, nurse or physician. Any follow up medical attention may be given at a local hospital and transportation to a Boston hospital is authorized. I give my consent for photographs, audiotapes, and video records of me/my child to be used by Boston Centers for Youth & Families for publicity purposes. I also agree to allow Boston Centers for Youth & Families to use photographs, audiotapes, video records or other work produced by the member for publicity purposes. *
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