Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

(1) Parent/ Guardian Name *

First Name

Last Name

(1) Parent/ Guardian Cell Phone *

(###)

###

####

Permission for Media Use: *

Do you grant permission for YWCA Greater Memphis to use photos/videos of your child for promotional purposes?

Yes, I grant permission

No, I do not grant permission

Acknowledgements and Waivers: *

By participating in this event, you agree to release YWCA Greater Memphis from any liability for injuries or incidents that may occur. In the event of an emergency, you authorize YWCA staff to seek medical care for your child if you cannot be reached. Additionally, you acknowledge that all children under 13 must be accompanied by a parent or guardian at all times and agree to ensure your child behaves respectfully throughout the event.

Yes, I agree

No, I do not agree