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2019 Superior YMCA Outdoor Soccer
This form is used for Roster Creation purposes and also serves as the waiver for participation. PAYMENT ON THE SEPARATE YMCA SYSTEM MUST ALSO TAKE PLACE FOR PARTICIPATION TO BE ALLOWED.
LAST name of child
FIRST name of child
Child's AGE as of MAY 15, 2019
CHILD's t-shirt size
Youth Extra Small
EMAIL of parent
YMCA staff organizes all practices but needs parental involvement. Are you able to help coach your child's team?
If YES to previous question: Have you coached youth sports in the past? (if NO to previous question, skip this and next question)
YES- other sport
What size coaches' shirt?
How did you hear about this program?
Signage @ the Y
Signage outside the Y
I hereby give my permission and approval for the above-named child to participate in all Outdoor Soccer activities during the 2019 season. I assume all risks and hazards incidental to such participation, and I release the YMCA, supervisors, and coaches from any claim arising from an incident or injury to my child. I also understand that the my child's photo may be used for future promotional efforts. If I object, I must communicate these wishes in an email or in writing to Jon Reimer, the YMCA's Activities Director. By answering this question, this will serves as my digital signature.
NO - my child will NOT participate in Outdoor Soccer
How do you intend to pay the participation fee, due BEFORE your child will be placed on a team?
I will pay in person @ the Y.
I will pay online at
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