Text Box: Christian County YMCA 900 McAdam Drive Taylorville, IL 62568 217.287.7271 217.824.2348 fax www.ccymca.org

Text Box: WINTER I & II PROGRAM REGISTRATION

Print this form out and fax it to the Christian County YMCA at 217-824-2348.

 

 

 Text Box: Name___________________________________________ Birthdate_____________Age______ Address_______________________________________________________________________ ______________________________________________________________________________Parent(s)_______________________________________________________________________ Home Phone_______________________________ Cell _________________________________ Emergency Contact: Name/#_______________________________________________________ Email:_________________________________________________________________________ For Office Use Only: Date Registered:_________ Amt. Pd.:_________ Received By:______ In Computer:______ ______________________________________________________________________________ Water Fitness: (circle) Aquatic Arthritis I— T/Th/F 8:30-9:15 Aquatic Arthritis II—M/W 10:30-11:15 Aquaerobics I—T/Th 9:15-10:00 Aquaerobics II—T/Th 6:15-7:00 Aquaerobics III—M/W/F 9:15-10:00 HydroFit I—T/Th 9:15-10:00 HydroFit II—T/Th 7:00-7:45 HydroFit III—M/W 4:15-5:00 Hit the Deck I—T/Th 10:00-10:15 Hit the Deck II—T/Th 7:45-8:00 Hit the Deck III—M/W 5:00-5:15 Yoqua—T/Th 7:45-8:30 Swim Lessons ____Parent/Child Lessons: Winter I—T 4:45-5:30 p.m. Winter II—W 9:15-10:00 a.m. ____Preschool Swim Lessons: T 4:00-4:45 p.m. ____Youth Swim Lessons: Th 4:00-4:45 p.m. ____Adult Swim Lessons: Winter I—W 5:15-6:00 p.m. Winter II—W 10:15-11:00 a.m. ____Swim Team: M/W/F 4:00-5:00 p.m. Youth Health, Well Being & Fitness ____Play (Positive Lifestyles and Activities for Youth) ____Youth Circuit Training ____Tae Kwon Do ____Youth Tumbling ____Youth Dance ____Tiny Tot Art ____Spring Outdoor Soccer League ____Golf Lessons ____Youth Basketball League ____Preschool Indoor Soccer ____Preschool Cheer Clinic ____Casimir Pulaski 3-on-3 ____Camp Illiniwek Adult Health, Well Being & Fitness ____Body Blast ____Triple Circuit ____Triple Threat ____Pilates ____Active Older Adult Stretching ____Boot Camp ____Tae Kwon Do ____SilverSneakers ____Personal Fitness ____Walking Program YMCA programs must have a minimum of 5 registered and regularly attending participants to be held beyond the first week of each session. Miscellaneous ____Birthday Party ____Other ________________________

 

Text Box: Please Sign Waiver: I, the participant or the parent or legal guardian of minor participant, agree that the Christian County YMCA will not be liable for any causes of injuries sustained out of the participation of the applicants in this/theseYMCA Program(s) and hereby release all said individuals from such claims and liabilities. The undersigned acknowledges that in all activities there are certain risks of physical injuries and all persons participate at their own risk. I hereby consent to the participation of the applicants in the above mentioned YMCA program(s) under the above mentioned conditions. Signed: ___________________________________ Date: _____________________