Serving those that serve America

Youth & Community Outreach Programs

Intersession Day Out

A FREE trip for military children to Petco Park to watch the San Diego Padres !

Wednesday, June 29th

Drop off: 9:00
Kids 10-15 years:
Military kids have an opportunity to experience an afternoon at Petco Park making new friends and learning about baseball. Tickets and transportation are provided, please bring a sack lunch for your child. For more information on Youth Programs throughout the summer visit www.militaryymca.org
Complete and return BOTH the registration and liability forms by June 24th to the ASYMCAHQ You can drop off forms at the office from 8:30 a.m. to 4:00 p.m. or fax forms to 858-751-5769
*Registration is first come first serve for the first 30 children. Children must be out of school to participant.

Pick up: 4:00

3293 Santo Road San Diego 92124 - Playground

Intersession Day Out REGISTRATION FORM

___________________________School: Child Name: ___________________________School: _______ Age: _____
Name:________________________ Active Duty Sponsor Name:________________________ Branch: __________ Rank: _______ Signature:_________________________________ Parent/Guardian Signature:_________________________________ Date: _______

San Diego Armed Services YMCA

3293 Santo Road, San Diego, CA 92124

Visit our website www.militaryymca.com for more information on the over 40 free programs and services available to your family!

Youth and Community Outreach Department Release of Liability Form: Adults and Minors

Parent/Guardian Name(s) (print)______________________________________________________________________ Parents Date(s) of Birth (same order)__________________________________________________________________ Address________________________________City_________________Zip____________Military Housing? Yes/No Email Address________________________________________Service Branch_____________________Rank______ Home Phone__________________________Work__________________________Cell__________________________ Emergency Contact________________________________________________________________________________ EC Home Phone_______________________EC Work_______________________EC Cell_______________________ Minor Children Participating: Name_____________________________________________________ Date of Birth_______________ Gender______ Name_____________________________________________________ Date of Birth_______________ Gender______ Name_____________________________________________________ Date of Birth_______________ Gender______ Activity or Group Location

Intersession Day Out Petco Park: Padres Stadium

Date(s)

June 29th, 2011

_

__

I, the undersigned parent/person having legal custody/guardianship of the above said minor, give permission for the minor to participate in the San Diego Armed Services YMCA program described above. I hereby grant full permission for my child and/or myself to be photographed by the San Diego Armed Services YMCA staff for any legitimate purpose without payment or compensation. The minor is physically able and mentally prepared to participate in all activities as described in the announcement for the program. I hereby voluntarily and knowingly assume all risks and dangers inherent and incidental to the activities of the program. I will not hold the San Diego Armed Service YMCA liable for any injuries incurred during the program or while my child(ren) is/are in transit to and from the program whether caused by equipment or the act or omissions of others excepting damage or injury solely caused by the willful misconduct or negligence of the San Diego Armed Services YMCA, or its employees, volunteers, or agents. I do hereby authorize the San Diego Armed Services YMCA as agent for the undersigned, to consent with respect to the minors, to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under general or special supervision of, any physician and surgeon licensed under the provisions of the California Medical Practice Act on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. I understand that the San Diego Armed Services YMCA is not responsible for costs incurred for medical care. If I participate in the program, whether as coach, instructor, aide, spectator, or participant, I presently waive as to the San Diego Armed Services YMCA and staff, officers and directors thereof, any claim presently known or unknown for damage to property or personal injury whether caused by equipment or the acts or omissions of others including San Diego Armed Services YMCA personnel.
_______YES My child(ren) can receive a healthy snack _______NO My child(ren) cannot receive a healthy snack

Food Allergies, if any:______________________________________________________________________________

****Parent/Guardian (Signature)____________________________________Date___________________****