2018 Superior YMCA Youth Volleyball
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 September 1, 2018
Child's BIRTHDATE (mm, dd, yyyy)
CHILD's t-shirt size
Youth Extra Small
EMAIL of parent
School attending this fall?
Four Corners Elem
Great Lakes Elem
Lake Superior Elem
Northern Lights Elem
60-minute practices are held at the Superior YMCA between 5:30-7:30pm. Which day(s) work for your family?
Each team is led by volunteer parent/coaches. Are you able to help out 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?
I hereby give my permission and approval for the above-named child to participate in all Youth Volleyball activities during the 2018 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 might be used for future promotional efforts and if I object, I must communicate these wishes in an email or in writing to Jon Reimer, the YMCA's Aquatic & Sports Director. By answering this question, this will serve as my digital signature.
NO - my child will NOT participate in Flag Football
Have you already PAID on the YMCA payment system?
I have/will pay in person with Superior YMCA desk staff
I have/will pay online at
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