Dodgeball @ the

Middle & High School Co-ed Dodge Ball has come to the Anderson Family YMCA. The league is open to both girls and boys in grades 6th-8th and 9th
12th who want to have a little fun!
Where:

Anderson Family YMCA

28 W. 12th Street
Anderson, IN 46016

When:

Saturday and Sunday

November 17th & 18th

Time: 7

7:00pm until done Saturday night

5:00pm until done Sunday

Cost:

Member Rate: $2
Non-Member Rate: $4
Registration Deadline: November 12th

Rules:

National Amateur Dodge ball Association

Registration Information

Name _____________________________________________________________________________________________ Age ________

Address ________________________________________________________________________________________
YMCA Member? Yes____ No ____

D.O.B. ______________________

City __________________

Zip _________________

ID. No. _________ Phone ______________

Emergency Contact __________________________________________________________________________

Phone _____________________________________________

Email Address ________________________________________________________________________________

I release the YMCA of Madison County, Inc. and any individuals associated with the YMCA from all claims or damages that may arise
from my participation. I verify that I am physically able to participate. This release shall apply to my heirs and personal representatives. If I sign this Release from a minor, or another family member, I also agree to indemnify the YMCA for any claim they may assert.
I have read this form and understand the expectations of the program's) which I have registered.
Date _____________ Parent/Guardian Signature: __________________________________________________
YMCA USE: Date: ____________

Amt. Pd. ____________

(Ca/CK/MC/V) Rec. ________________