Laserfiche WebLink
<br />REGISTRATION FORM: <br /> <br />Name: <br />Address: <br />Phone: Emergency Contacts: <br />Doctor's Name and Number: <br />Health or Physical Concerns: <br /> <br />1._parents Night Out <br /> <br />Check Event: <br />4/15/05 <br />5: 30p.m.-8: 30p.m. <br /> <br />Name and ages of Children <br /> <br />2._ Varieties <br /> <br />4/09/05, 5/07/05, 5/14/05 <br />11 :00a.m.-12 :OOp.m. <br /> <br />Name and ages of participants <br /> <br />Paint shirt sizes <br /> <br />YS_ YM YL_ YXL_ <br /> <br />Total Amount Enclosed $ <br />Check Number <br />Mail Registration Form and Check to: <br />Chain of Lakes YMCA <br />c/o Northwest YMCA <br />3760 Lexington Ave N. <br />Shoreview, MN 55126 <br /> <br />The YMCA has my permission to use photographs of my child for promotional purposes. Initials <br />As parent/guardian of this child, I agree to hold the YMCA harmless from any and all claims. I authorize the <br />YMCA staff to give my child reasonable first aid and to transport my child to a health car facility for emergency <br />services as needed. I hereby acknowledge that the YMCA will assume that either parent of the child may pick <br />up the child at anytime during the program unless notified through court documentation. <br />Signature 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. Please let us know if we may serve your family in this way. <br /> <br />\~ <br />