Wilson MSAS Registration Form

I understand that even when every reasonable precaution is taken, accidents may occur. Therefore, in exchange for the Wilson YMCA (hereinafter referred to as "Y") allowing my child to participate in Y activities, I understand and expressly acknowledge that when he/she uses the Y facility or program, they do so at their own risk. I understand that the Y will make every effort to contact me in case of an emergency pertaining to my child. If I am unable to be reached, the Y will try to contact an alternate adult listed on the registration form. The Y has my permission to secure medical attention for my child in the event of an emergency. I released the Y, its staff, directors, officer and agents from all liability for any injury, damage or sickness connected in any way whatsoever to participation in Y activities, whether on or off Y premises. I understand that this release indicates, but is not limited to, any claims based on negligence, action, or inaction of the Y, its staff, directors, officers, members, agents, representatives, or guests. I authorize the staff of the Y, or appropriate medical personnel, to administer emergency medical treatment to my child or me. I also understand that I am solely responsible for all costs incurred as a result of such medical treatment. Furthermore, I agree and grant permission to the Y to use photographs or video of my child or me in Y brochures, flyers, photo collections and other marketing initiatives. I agree that only the adults on this form are allowed to remove my child from the Y program unless I notify the Y in writing. Under no circumstances will phone call authorizing child-pick-ups be accepted at any time I have read, understood and voluntarily signed this agreement.