ELW Youth Association, Inc. - Summer 2019 Registration
POST OFFICE BOX 722 | CARTERSVILLLE, GEORGIA 30120
(404) 725-3376 (phone) | infoelwyouth@gmail.com (email)
Email address *
IMAGINE | DISCOVER | EXPERIENCE
Deadline for Registration Forms:
* May 30 - Summer Program Activities
* May 30 - Basketball League


PROGRAM ACTIVITIES
Summer program activities are FREE for youth, ages 6-17, in the Cartersville/Bartow County Community.

All participants (ages 6-17) in the basketball activity June 10-18 must also register and participate in the Read/Write/Now activity June 10-13
Basketball League (June 1 - July 13)
Summer basketball league is $50.00 for Bartow residents and $65.00 for non-residents. No checks will be accepted.

Teams will practice once a week and games will be played on Saturdays. Exact practice and game times will be determined once registration is completed.
Participants must complete the ELW Summer Basketball League Waiver form>> https://forms.gle/GAwxC73DD5ZWoyWb7
Registration fee is due upon signup. Registration will not be considered complete by ELW, and a spot will not be held on any team, until full payment has been received. Checks will not be accepted. Pay now via PayPal>> http://www.paypal.me/ElwFutureStars
Participant
Last Name
Your answer
First Name
Your answer
Nickname/Goes by
Your answer
Birthdate
MM
/
DD
/
YYYY
Address
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City
Your answer
Zipcode
Your answer
School
Your answer
Grade
Allergies (list all)
Your answer
Lactose Intolerant?
Parent/Guardian
Name
Your answer
Cell Phone
Your answer
Home Phone
Your answer
Work Phone
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone
Your answer
READ & SIGN
I, the parent/guardian of the above named individual, hereby give permission for his/ her participation in the activitiesherein, and assume all risks and hazard incidental to the activity, and release, absolve, indemnify and hold harmless the ELW Youth Association, Inc., the organizers, supervisors, employees, volunteers, and any sponsor of the facility providers, including but not limited to the Cartersville Board of Education, the City of Cartersville and Government, and Etowah Area Consolidated Housing Authority. I also release responsibility any person transporting above named to or from the hospital in case of injury.I also consent for my child’s photo to be used for ELW Youth Association, Inc. advertisement. I give permission for him/she to attend the ELW Youth Association, Inc. group field trip if available. All program and basketball league participants must participate in the Social Intervention & Life Skills and Read, Write, Now Programs. *
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Signature (Type Name) *
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A copy of your responses will be emailed to the address you provided.
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