Monroeville Area YMCA 2013 Makos

Swim Team
Its Time to hit the Pool Swimming
The 2013 Makos Swim Team signups are here.
Ages 5-15
COST: Members $100 / Non-Members $120
(For the Entire Summer Program)
Swimsuit, Goggles, & Championships Meets are Separate Charges.
Registration May 1st 20th

For Question please feel free to contact the YMCA @251.575.9622

Evaluations TBA
Must be able to pass evaluation
Practice times and start date: TBA

Swimmer __________________________________________________
Member
Non- Member
Age___________________ Birthday___________________________ Gender ___________________
Shirt Size__________________
Address___________________________________________________________________________________
_____
City____________________________________ Zip code ___________________________
Mother: ____________________________ Cell #___________________________ Email
__________________________
Father: _____________________________ Cell # _________________________ Email
_________________________
I do herby give my permissions for my child(ren) to be treated by any duly licensed medical personnel in the
event that they become ill or injured while participating in the Monroeville Area Ymca Programs. I hereby
agree to fully and completely indemnify and hold harmless the Monroeville Area YMCA, and all of its
employees, volunteers and board member from and against any and all claims, demands, suits, debts and
causes of action of any nature whatsoever arising from or out of personal injury sustained while participating
in any Monroeville Area YMCA programs.
_______ I hereby affirm my child is not covered by a personal insurance policy.
_______ I hereby affirm my child is covered by a personal insurance policy.

Insurance company:_______________________________ Policy/ Contract #:___________________________

Parent Signature: ____________________________________________________ Date:
________________________