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Boys & Girls
Youth Flag Football League
Monroeville Area YMCA
Evaluations October 23rd Only Ages (3 16)
Games Start November 4th
Registration begins September 15th - October 10th.
Late Registration October 11th- October 15th
Members: $45
Program Participant $60
Late Registration $10
Sibling Discount $5
For more information contact Program Director Justin Marshall
251.575.9622 justin_ymca@frontier.com

Registration: Now October 10th

Practice and Games will be played at the YMCA
For Boys & Girls Ages 3-16
Players Full Name ______________________________________________________ Birthdate
______/_____/______ AGE _______
Address:_________________________________________________________ City
___________________________ Zip _________________
Name of Parents/
Guardians___________________________________________________________________________
_____________
Mother __________________________ Cell# _____________________________ Email
__________________________________________
Father ___________________________ Cell# _____________________________ Email
__________________________________________
Emergency Contact ___________________________________________ Cell#
_________________________________________
Shirt Size (Circle one) YS YM

YL

AS

AM

AL

AXL

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.
If your child has any Allergies, Asthmatic conditions, or any hindrances that may affect your childs ability that the YMCA should be aware of please
list below.

___________________________________________________________________________________
__________________________________________
In witness whereof, I have executed this Registration, Waiver/Release and Medical Certification form
with full knowledge of its contents on: __________ (Month) _____________ (Day) __________ (Year)
Parent/ Guardian Signature ______________________________________ Print Name
___________________________________

VOLUNTEERS NEEDED!!!
Please Circle One:

Head Coach

Assistant Coach

Referee/ Umpire

Office Use Only:

Date Registered ______________________ Registered By __________________________ Amount Paid
$_______________________