Town North Family YMCA Sports Leagues Individual Waiver

Player’s Name: ________________________________________________ Home Address: _____________________________________________ Town & Zip Code: ___________________________________________ Home Phone: _____________________________________________ Home or Work Email: ________________________________________ Work Phone: _______________________________________________ D.O.B._______________________ Gender: M or F Please circle one of the following:
Fall Winter Spring Summer Sport: _____Soccer_________________________ Team Name: _Dealey Dragons_____________________ Coach’s Name: _________________________________ Town North Family YMCA BEHAVIOR POLICY:
The YMCA reserves the right to warn, suspend, or dismiss any program participant or member from our programs and facilities upon the following conditions: • If their behavior poses a threat to themselves or others • If they require an inordinate amount of attention from the staff thereby causing inadequate levels of supervision for the remainder of the participants or members • If their behavior is determined to be inappropriate within the scope and spirit of the YMCA values • For any reason within the discretion of YMCA management.

By my signature and of my free will , I do hereby agree to indemnify and save harmless the YMCA of Metropolitan Dallas from any and all claims or demands, costs or expenses arising out of any injuries, damages or other losses, whether personal or property, sustained by me or any party to whom I am responsible. By my signature I acknowledge that I have been given information to read with regards to other YMCA policies. Signature of Parent: __________________________________________________ Date: ______________________________________

Town North Family YMCA 4332 Northaven Rd. Dallas, TX 75229 Phone: 214-357-8431 Office Fax: 214-357-2986

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