Basic & Teen Strength Trng Participant Info

First Name

Last Name

Age

Gender

Female

Male

Address

City/Town

State/Province

ZIP/Postal Code

Phone

Contact Email

If you are registering for Teen Strength Training (ages 12-17), parent information is required.

Parent/Guardian Name

Parent/Guardian Phone

Parent/Guardian Email

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relation

Which facility do you want to train?

Bellingham YMCA

Which Program?

Basic Strength Training Instruction

Teen Strength Training

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

I understand that the program will involve a certain degree of strenuous physical activity. I agree to assume all risks associated with the program and further agree to hold the YMCA harmless from and against any and all liability, loss, claims, costs and expenses, for both personal injury and/or property damage, including attorney fees, which may arise as a result of my participation in the YMCA Strength Training Programs.

In the event of an emergency, and emergency contact cannot be reached, I hereby authorize the YMCA to obtain medical treatment for myself or my teen at my expense.

These programs are designed for beginners. If 12-17 years old, teens with strength training experience may test out in a Basic Weight Room Instruction. If the teen tests out successfully, the teen member be approved to use the weight room without adult supervision.

Participant Signature (or Parent/Guardian Signature if participant 12-17 years)

Sign above

Today's Date