WWFY Minor Participant Waiver

Westport Weston Family YMCA Participant Waiver

In an effort to keep our members and facilities safe, and in order to use the facilities, all members and guests including a parent/guardian for minor participants under the age of 18 are required to agree and sign our Waiver and Release of Liability.
MINOR PARTICIPANT INFORMATION
Participant Name*

First NameLast Name
Participant Date of Birth*

MonthDayYear
Date
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Date of Birth*

MonthDayYear
Date
Relationship to Participant*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com

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Would you like to provide emergency contact information instead of the parent/guardian information provided above?**

YesNo
Emergency Contact Name*

First NameLast Name
Relationship to Participant*
Phone Number*

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Program/Event*
Which program or event will they be attending?
Program/Event Date*

MonthDayYear
Date
AGREEMENTS

PLEASE READ THE FOLLOWING CAREFULLY. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS AND THOSE OF YOUR MINOR CHILD AND IS LEGALLY BINDING. BY SIGNING THIS AGREEMENT YOU ON BEHALF OF YOURSELF AND YOUR MINOR CHILD ARE RELEASING THE WESTPORT WESTON FAMILY YMCA FROM ALL LIABILITY AND FOREVER GIVING UP ANY CLAIMS THEREFORE.
Signature*
Date*

MonthDayYear
Date
Should be Empty: