San Pedro & Peninsula YMCA Circle either then write size

Youth or Adult
Indoor Soccer Registration Form
Size: _____

Name of Player: _________________________________________ Sex: ____ Birth Date: ____ /____ /____ Age: _____
(Last) (First)

School: ____________________________________ Grade: ______

Email: __________________________________________________________

Address: __________________________________________ City: __________________________ Zip: ____________

Home Tele.: ( __ ) _____________________ Alt. Tele.: ( __ )________________________

Parent/Guardian(s) name(s): _________________________________________________________

(Last) (First)

Parent/Guardian(s) name(s): _________________________________________________________

(Last) (First)

Emergency Contact: ______________________________________________ Phone: (____) _____ - _______

(Last) (First)

Agreement (Youth Sports Program Only)

1. I hereby certify that my child is capable of safe participation in the youth sports program.
2. I assume all risk(s) and hazards incidental to the conduct of this program and for the transportation to and from the program. I hereby authorize the
YMCA to obtain medical treatment for my child in the event that parent(s) and the emergency contact cannot be reached.
3. I will have a parent or guardian present at all times for practices and games and will not have coaches transport my children.
4. I support YMCA Youth Sports philosophy, which is based on participation, fun, physical fitness and health, skill development, teamwork, fair play,
family involvement and volunteer in support of this program as a:
5. I agree to uphold the San Pedro & Peninsula YMCA Youth Sports Code of Conduct. All team members, coaches, parents, supporters and players
must commit to a high standard of conduct at all times. YMCA Rules are to be observed at all times. Violations with regards to the use of profanity, loud
or rowdy behavior, ridiculing players, fans, referees, fighting, and arguing may result in suspension from the YMCA League.

Signed: ____________________________________________ ________________

Parent or Legal Guardian Date

Parent Permission Form (Youth Sports Program Only)

The undersigned as parent or legal guardian of _____________________________ hereby authorizes the YMCA, its delegated leaders and directors
to consent to any medical and hospital care to be rendered to said minor upon the advice of a licensed physician. This authorization is given pursuant
to the provisions of section 25:8 of the Civil Code of California. It is understood that if time and circumstances reasonably permit, the YMCA will
endeavor, but is not required, to communicate with me prior to such treatment. The undersigned further agrees that the YMCA and its designated
leaders and directors are not legally or financially liable for any claim arising from any consent given in good faith in connection with such diagnosis or
advised treatment. This authorization and consent to treatment of a minor is given to the YMCA in conjunction with any authorized event.

Signed: ____________________________________________ ________________

Parent or Legal Guardian Date

REFUND POLICY: Full refunds will be granted prior to the first practice of the season ONLY. Partial refunds minus the cost of the uniform and a $20
processing fee will be granted through the second week of the season. NO refunds will be granted after the second week of the season.

BY SIGNING BELOW I HAVE READ AND UNDERSTAND THE SAN PEDRO & PENINSULA YMCA REFUND POLICY

Signed: __________________________________________ ______________

Parent or Legal Guardian Date

If registering on line, you may fax this form to (310) 548-8607, or mail to:
San Pedro & Peninsula YMCA 301 S. Bandini St., San Pedro, CA 90731, Attn: Sports Coordinator