NON-PROFIT ORG PRSRT STD PERMIT NO. 332 STOCKTON, CA ANY GIVEN SATURDAY! When kids play Y-Sports they learn more than skills – they develop character. We impart our four core values: honesty, respect, caring and responsibility, at all of our practices and games. The Y is the only game in town that builds a healthy mind, body and spirit! FLAG FOOTBALL Football (Age 5-6, 7-8, 9-10, 11-12) September 6, 2014 - October 18, 2014 • One practice per week, day/time selected by coach. All games are on Saturday. Fútbol Americano (Edad 5-6, 7-8, 9-10, 11-12) 6 de Septiembre 2014 - 18 de Octubre 2014 • Una práctica a la semana, día / hora seleccionado por el entrenador. Todos los juegos son el sábado. Return completed form with payment to: YMCA of San Joaquin County 2105 W March Lane Suite 1 Stockton, CA 95207 P: (209) 472-9622 F: (209) 472-9625 www.ymcasjc.org facebook.com/sjcymca READY FOR SOME FOOTBALL? YMCA of San Joaquin County 2105 W March Lane Suite 1 Stockton, CA 95207 Cuando los niños juegan en Y-Deportes aprenden más que solo habilidades - desarrollan carácter. Impartimos nuestros cuatro valores fundamentales: honestidad, respeto, cuidado y responsabilidad en todas nuestras prácticas y juegos. La Y es el único juego en la ciudad que construye una mente sana, cuerpo y espíritu! STOCKTON Sign up by August 22, 2014 Starts on September 6, 2014! ymcasjc.org facebook.com/sjcymca FLAG FOOTBALL - REGISTRATION FORM Child’s Name: _________________________________________________________________________________ How would you descirbe your child’s skill level? Age: ____________ Date of Birth: _________________________________ M: F: BeginnerIntermediate Expert Address: _______________________________________________________________________________________ City: ______________________________________________________ Zip: _______________________________ Home Phone: __________________________________________________________________________________ School: ___________________________________________________ Grade: ___________________________ Parent / Guardian: ___________________________________________________________________________ Work Phone: ____________________________________________ DOB: _____________________________ Email: ___________________________________________________________________________________________ Special Needs / Physical Limitations / Allergies / Medications: ___________________________________________________________________________________________________ How did you hear about this program? __________________________________________________ Annual Membership Fee: $10 Registration Fee: $90 A $10 late fee may be applied to any registration received after August 22, 2014. You must register by the deadline to guarantee your spot in the program. • A $10 cancellation fee will apply. No refunds will be given after the start of games. • Financial assistance is available for those who qualify. Applications must be recieved by the registration deadline. ___________________________________________________________________________________________________ - PRECIO - Sports Shorts! Would you like to purchase YMCA shorts to go with your uniform? If so, please include an additional $10 with your registration and select your child’s size below: YXSYSYMYLASAMALAXL Request Coach: _______________________________________________________________________________ Request Player: _______________________________________________________________________________ Volunteer! Our youth sports programs would not be possible without the time and effort of selfless volunteers such as yourself. Please consider showing your support for the YMCA by volunteering today! Emergency Contact Phone: _________________________________________________________________ Head coaches who attend the coach’s clinic, coach’s meeting and are in good standing with the YMCA at the end of the season will recieve a $20 credit on their account that can be used towards a future sports registration. Child’s T-shirt (Check One): Volunteer Name: ______________________________________________________________________________ YXSYSYMYLASAMALAXL Coach Asst. Coach Team Parent Emergency Contact: _________________________________________________________________________ Waiver of Liability: I hereby accept any and all responsibility for, and assume the risk of any and all injury or damage to my person or dependent children which might arise directly as a result of, and or participation in the YMCA of San Joaquin County, the various branches and subdivisions thereof, and all employees and volunteers in their capacities as representatives of the YMCA expressly including, but not limited to the Board of Directors of the YMCA of San Joaquin County except injuries caused intentionally, or by willful misconduct. I give my permission for my children (s) picture to be used as a promotion for the YMCA. I certify that I am familiar with the contents of this release, that I have read and understand the same, and that it is my intention by my heirs, administrators, executors, successors, and assigns. ___________________________________________________________________________________________________ Parent / Guardian (Please print clearly) - PRICE - Volunteer’s T-shirt (Check One): S M L XLXXL • • • • • • • • • • Cuota Anual: $10 Tasa de Registro: $90 Una cuota de $10 se aplica a cualquier registro recibido después del 22 de Agosto del 2014. Usted debe registrarse en la fecha límite para garantizar su lugar en el programa. Se aplicará un cargo por cancelación de $10. No se harán reembolsos después del inicio de los juegos. Hay asistencia financiera disponible para aquellos que califiquen. Las solicitudes deberán ser recibido dentro del plazo de inscripción. aquellos que califiquen. YMCA Parent Shirt! Are you unable to volunteer, but eager to show your Y spirit? Support your child with an official Y Parent shirt in the same color as their team. Please include an additional $10 with your registration and select your size below: S M L XLXXL Sponsor a team! The YMCA receives a large amount of requests for scholarships to participate in our sports programs. Please help us provide financial aid to these deserving applicants by making a donation or sponsoring a team for just $300. Call our office today at (209) 472-9622 to find out how! ___________________________________________________________________________________________________ SignatureDate Note: This program is not related to nor endorsed by Stockton Unified School District; it is solely offered and managed by the YMCA of San Joaquin County.