HEALTHY KIDS
FIELD DAY
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HEALTHY
KIDS
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HEALTHY
FAMILIES
HEALTHY
COMMUNITIES
YMCA OF LENAWEE COUNTY
ADRIAN COLLEGE
APRIL 13, 2014
12 TO 3 PM
FREE FUN, FOOD AND FITNESS!
All students in Lenawee County Grades K-6 are invited!
Held at the Merillat Sports & Fitness Center at Adrian College
Activities include: Dodgeball, Soccer, Basketball, Track & Field , Obstacle Course, &
more!
PLEASE REGISTER BY APRIL 3
Student’s Name ___________________________________________________Age________
School ______________________________________________Grade_______
T-shirt size __________ (Youth- S, M, L, XL or Adult S, M, L) Please circle or write out.
Email ____________________________________________________________
By signing this form, I understand and assume the risk that my child may encounter at the
Adrian College/ YMCA Healthy Kids Field Day 2014. I hereby release Adrian College, the YMCA
of Lenawee County and any associated persons or employees from any claims for any
injuries, personal losses, or damage done to personal property while on the premises of
Adrian College, the YMCA of Lenawee County or properties associated with specific
programs of the organization. I further agree to indemnify and save harmless Adrian College
and the YMCA of Lenawee County from any claims or demands arising out of any such injuries
or losses. I authorize the publication of any photography taken for this program for the use
of promoting or advertising further programs, unless I notify the YMCA of my desire to not
permit any published photos at the time of registration.
Parent/Guardian Signature ___________________________________________Date _________________
Parent/Guardian Phone # _________________________________________________________________
Emergency Contacts (name, relationship, cell/home phone number)
_________________________________________________________________________________________________
Medical Conditions/Allergies _______________________________________________________________
Persons authorized to pick up your child ___________________________________________________
_________________________________________________________________________________________________
Registration forms can be dropped off, or mailed to:
YMCA of Lenawee County
638 W. Maumee St
Adrian, MI 49221
Attn: Rachel Doyle
* Questions please call 517.417.6111
REGISTRATION DEADLINE (with T-shirt) : Thursday, April 3, 2014
Registrations are permitted through April 11, however a T-shirt is not guaranteed if registering after 4/3.