NAME_____________________________________ADDRESS_____________________________________________D.O.B._____________

GRADE_____________________ SHIRT SIZE_____________________

PARENT/GUARDIAN_________________________________HOME #_________________________WORK #___________________________

INTERESTED IN COACHING? Y N __________________________INTERESTED IN SPONSORING? Y N _________________________

SPECIAL CIRCUMSTANCES_________________________________________________________________________________________________

Liability and Photo Waiver: It is specifically understood that participation in HRC Sports has potential dangers. I acknowledge that potential
and understand that HRC, its' partner entities, its' agents and its' coaches and officials are not liable for any claims arising out of injury or accident
unless occasioned by wanton and willful negligence. I hereby give permission to HRC to use any and all photographs taken of me or my child
for posting to the website, on printed materials or other media. I hereby waive any rights or interests that I might have in any or all images
without compensation to me.


Signature of Parent or Guardian_______________________________________________Date________________

Office Use Only

Receipt #__________________Check #_________________ Cash_________Amt____________Staff__________

SPORT (Be Specific)______________________________________Fee_____________
                
 (ex. YMCA Girls' Basketball 3rd-4th grade, REC Baseball - Minor II)

Form must be printed off and mailed into HRC Offices accompanied by payment.

Form not valid for YMCA Tackle Football or Hook A Kid On Golf Program.