YOUR SAFETY MATTERS

If you are the parent or legal guardian of a child registered for a youth program at the Berkshire Family YMCA, you will be required to sign the following waiver and medical condition confirmation for each program:

WAIVER/RELEASE

  1. I certify that my child is in normal health and capable of participating in the Y’s youth athletics. I do acknowledge the risk of injury is possible. I grant permission for my child to play and in doing so I hereby release all rights and claims for injuries and damages I may have against the Pittsfield Family YMCA, its board, managers, employees, officials, volunteers and coaches. If medical attention is required, I give my permission for such medical care when either the emergency contact person or I cannot be notified. I understand that the Pittsfield Family YMCA does not carry accident insurance on program participants.
  2. I agree the Y may photo or videotape my child and use it for its promotion.
  3. Parents are responsible for providing transportation for their child to/from this class.
  4. I support the Y program philosophy, which is based on participation, fun, physical fitness and health, skill development, teamwork, fair play, family involvement and volunteer leadership.

MEDICAL CERTIFICATION

If your child has any allergies, asthmatic conditions or any hindrances that may affect his/her ability to participate, please list: [List]

In witness thereof, I have executed this registration, waiver/release and medical certification form with full knowledge of its contents on this date: [Date]