Laserfiche WebLink
<br />Registration Form <br /> <br />Centerville's Laurie LaMotte Memorial Park <br />Park Play Days <br /> <br />Participant's Names & Ages <br /> <br />Address: <br /> <br />Phone: <br /> <br />Emergency Contact and Number <br /> <br />Doctor's Name and <br />Number: <br /> <br />Health or Physical Concerns: <br /> <br />June 19- July 19 ($48Ichlld) <br />July 24-August 18 ($48Ichild) <br /> <br />Total Amount Enclosed $ . <br />Check Number <br />Mail Registration Fonn and Check to: YMCA-laC he lie Williams. 600 Town Center, <br />Lino Lakes, MN 55014. 651-195-9622 <br />www.ymcatwincities.org. Make checks out to Chain of Lakes YMCA. <br />The YMCA has my pennlsslon to use photographs of my child for promotional purposes. Inltlals_ <br />As parent/guardian of this chUd, I agree to hold the <br />YMCA hannless from an)' and an claims. I authorize the YMCA staff to give my child reasonable first aid and to <br />transport my child to a health care facility for emergency services as needed. I hereby acknowledge that the <br />YMCA wiD assume that either parent of the child may pick up the child at anytime during the program unless <br />notified through court documentation. <br /> <br />Signature <br />Date <br /> <br />The YMCA welcomes all who wish to participate and annually raises funds through our Y Partners campaign to <br />help make that possible. <br />Please let us know if we may serve your family in this way. <br /> <br />Chain of lakes YMCA Summer '06 <br />