Please print the participation form, fill it out and mail it with your form of payment to:
South Lake YMCA
PO Box 120910
Clermont, FL 34712
Registration Fees:
Ages 3-4
Members $55
Non-Members $60
Ages 5-15
Members $70
Non-Members $75
Participant Name _________________________ Sport _________________ Age ___________ Grade ________
Address:_____________________________________________________________________________________
City:____________________________ State:_________ Zip:_____________ E-Mail:______________________
Parent/Guardian Name:_________________________________________ Phone:_________________________
Emergency Contact:___________________________________________ Phone:_________________________
Shirt Size: YS (6-8) YM (10-12) YL (14-16) AS AL AXL XXL
Method of Payment: Visa Mastercard Check Cash
Card Number:_____________________________________________________ Expiration:__________________
I hereby authorize the staff of the Central Florida YMCA to act for me according to their best judgment in any emergency requiring medical attention, and I hereby waive and release the Central Florida YMCA from any and all liability for any injuries or accidents incurred while participating in the program. I have no knowledge of any physical impairment that would be affected by the above named participation in the program. I also understand that Central Florida YMCA retains the right to use for publicity and advertising purposes photographs of the participants.
Parent/Guardian Signature:________________________________________________ Date:________________
