Monroeville Area YMCA 2020 Fall Soccer Registration
Registration now - August 23rd
Cost: Member $35/50 / Program Participants $45/65 (4 & Under / 5 -12)
For More information contact Justin Marshall Program Director
Players First Name
Players Last Name
Childs Race/ Ethnicity
Black or African American
Hispanic or Latino
Native American or American Indian
Asian / Pacific Islander
Do not wish to answer
Players Shirt Size
Mailing Address (Address, City, State, Zip)
Name of Parent / Guardian #1
Contact Number of Parent / Guardian #1
Name of Parent / Guardian #2
Contact Number of Parent / Guardian #2
Referee / Umpire
Name & Number of Volunteer
Volunteer Shirt Size
PARTICIPATION WAIVER: I certify that this child is in normal health and capable of participating in the YMCA youth athletics. I do acknowledge the risk of injury is possible. I grant permission for my child to play and in doing so I hereby release any and all rights and claims for injuries and damages I may have against the YMCA their Board, Manager, Employees, Officials, Volunteers and Coaches. If medical attention is required, I give my permission for such medical care when either I or the emergency contact person cannot be notified. I understand that the YMCA does not carry accident insurance on league participants. I agree that the YMCA may photo or videotape my child and use it for their promotions. Parents are responsible for providing transportation for their child to and from practice and games. Sign below by typing your name.
COVID 19 WAIVER: With regard to the current COVID 19 health crisis and related concerns, I hereby assume full responsibility for any health risk associated with this virus or any other illness as it relates to my use, or the use of a minor for whom I am signing for, of and entrance into any facility or area owned or operated by the Monroeville Area YMCA. I, for myself, my heirs, executors, administrators, and/or for the minor(s) for whom I am signing, release and forever discharge the Monroeville Area YMCA and its officers, employees, directors, agents, servants, and all persons connected with the YMCA, of and from any and all rights, claims, demands, and actions of any and every nature whatsoever, for any and all loss, damage, injuries sustained by me or my property, or by the minor(s) for whom I am signing or his/her property at any time. If I am participating in the YMCA Nationwide Membership Program, I agree to release the National Council of Young Men’s Christian Associations of the United States of America, and its independent and autonomous member associations in the United States and Puerto Rico, from claims of negligence for bodily injury or death in connection with the use of YMCA facilities, and from any liability for other claims, including loss of property, to the fullest extent of the law. Type your name below to sign this Waiver.
If you are currently a YMCA member and would like us to draft your registration fee please check the box below.
Yes Draft my Account
I will pay at the YMCA before the season starts
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This form was created inside of Monroeville Area YMCA.