YWCA Women’s Monday Night Volleyball League
September 12-December 5, 2016
REGISTRATION FORM
Team Number:__________
Team Sponsor Name:__________________________________
Name:__________________________________________________________________________________
Address:________________________________________________________________________________
City
State
Zip Code
Phone Number ____________________________Email:__________________________________________
In Case of Emergency Notify: ________________________________________________________________
Relationship: ___________________________ContactNumber:_____________________________________
Player Registration $25
YWCA Membership fee $30 (all players must be YWCA member)
Sponsor Fee $100 (paid by sponsor on ________________)
(date)
WAIVER OF LIABILITY
I do hereby waive, release and forever discharge the YWCA of Genesee County, Inc. its officers, agents,
employees, representatives, executors and all others from any and all responsibilities or liabilities for injuries or
damages resulting from my participation in any activities of the YWCA of Genesee County, Inc. The YWCA of
Genesee County, Inc. has my permission to use photos, videos, and audiotapes taken of me or minor children
in my family for the purpose of publicizing YWCA activities without any remuneration or compensation.
________________________________________________________________________________________
Signature
Date
Enclosed is my check payable to the YWCA of Genesee County, Inc. OR
Mastercard ( )Visa ( )
Credit Card #_________________________ Exp. Date:____________3 digit code __________
FOR OFFICE USE ONLY
Initials______ Date Paid___________
Amount Paid________ Check/CC___
$25 per player
YWCA of Genesee County, Inc.
301 North Street, Batavia, NY, 14020
P 585.343.5808 F 585.343.0143
ywcagenesee.org