• I hereby certify that my child is in normal health and capable of safe participation in the program in which he or she is enrolling.

• I further give my permission for my child to be given emergency medical treatment by a qualified Whatcom Family YMCA staff until parents can be reached and be present and/or emergency care arrives for treatment. In case of emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency resources deem it necessary. In the event that I cannot be contacted, I further consent to the medical, surgical and hospital care to be performed for my child by a licensed physician or hospital when deemed immediately necessary by the physician to safeguard my child’s health. It is understood that in some medical situations, the staff will need to contacted the local emergency resources before the parents, child’s physician and/or other adults acting on the parent’s behalf.

• I, the below signed person, having legal custody/guardianship of said minor, give permission for said minor to attend any YMCA program activities supervised by authorized YMCA staff.

• I have enclosed the appropriate deposit and registration fee as indicated above. I understand that these are both NON-REFUNDABLE AND NON-TRANSFERABLE. I understand that final payment is due according to the Parent Handbook & that failure to pay balances by the due date may result in the cancellation of this registration.

• MEDICAL AUTHORIZATION & LIABILITY RELEASE: As a parent/legal guardian, I hereby agree to hold harmless the YMCA staff, directors and volunteers from liability for any accidents resulting from participation and consent to the YMCA to secure emergency care as needed or prescribed at my expense for my child. This care may be given under whatever conditions are necessary to preserve life, limb or well being of my child. I also give permission to the YMCA to provide transportation as needed for my child in case of emergency, at my expense. I understand that it is my responsibility to inform the YMCA of any changes to my child’s health.

• SWIMMING ABILITY: I understand that on my child’s first visit to YMCA pools, my child will participate in a swim test. He/she will be placed into the appropriate swim level according to the lifeguard’s evaluation as described in the parent handbook. Life jackets are available for those who require them based on swim test.

• CLIMBING WALL RELEASE: In consideration of the YMCA allowing the above named child to use the Climbing Wall, I the undersigned user, agree to indemnify & hold harmless the YMCA, its officers, directors, agents & employees, from all causes of action, claims, demands, losses & consequence of the neglect of the YMCA in safeguarding my use of the Climbing Wall, or because of any act, neglect or misconduct of the YMCA, its officers, agents & employees.

• CONCUSSION INFORMATION: Anyone who is suspected of sustaining a concussion or head injury in a practice or a game shall be removed from competition at that time and may not return to play until the participant is evaluated by licensed health care provider trained in the evaluation and management of concussions and received written clearance to return from that health care provider. You should also inform your child’s coach/teacher if you think that your child may have a concussion. Remember that it is better to miss one practice/game than to miss the whole session. WHEN IN DOUBT, THE PARTICIPANTS SITS OUT.
For more information go to http://www.ede.gov/concussion/HeadsUP/youth.html.

Please check each box to accept the options below:

LIABILITY WAIVER:

In consideration of being permitted to utilize the facilities, services and programs of the Whatcom Family YMCA (“YMCA”) for any purpose including, but not limited to observation or use of facilities and equipment and participation in any program affiliated with the YMCA without respect to location. I, on behalf of myself and any children, dependent or personal representatives, hereby:

1. Acknowledge that I have (a) read this release and waiver of liability; (b) had the opportunity to inspect the YMCA’s facilities and equipment or will immediately upon entering or participating will inspect and carefully consider such premises, facilities or program; (c) accept the facilities, equipment and program as being safe and reasonably suited for the purposes intended; (d) voluntarily sign this release and waiver of liability.

2. Release the YMCA, its directors, officers, employees, agents and volunteers (collectively “YMCA Releases”) from all liability to me for any loss or damage to property or injury or death to person, whether caused by the ordinary negligence of the YMCA Releases or any other person, and while I am in, upon or about any YMCA branch or any facilities or equipment therein or participating in any program or service affiliated with the YMCA.

3. Agree not to sue the YMCA Releases for any loss, liability, damage, injury or death described above and I agree to indemnify and hold harmless the YMCA Releases and each of them from any loss, damage or cost they may incur due to my child’s participation in, upon or about any YMCA branch or any facilities or equipment therein or my child’s participation in any program or service affiliated with the YMCA whether caused by the ordinary negligence of the YMCA Releases or by any other person. I assume full responsibility for the risk of such loss, liability, damage, injury or death.

I intend for this release and waiver of liability to be as broad and inclusive as is permitted by the laws of the state of Washington if any portions hereof is held invalid, I agree that the balance shall continue in full force and effect.