MAIL IN PROGRAM REGISTRATION FORM (ONE PER PARTICIPANT ) 
Print this form on your printer, fill in the required information (please print) and mail it to
The Sandusky Area YMCA, 2101 W. Perkins Ave., Sandusky, OH  44870  

Address: ___________________________________City: ____________________ Zip: _________________

Home Phone: __________________________________ Work Phone: _______________________________  

Emergency Contact:  ___________________________________________ Phone: ______________________

T-Shirt Size: ________________   

Are you willing to volunteer?  ________  Name of volunteer _______________________________________ 

Class Name: _______________________________________ Day ________________ Time: _______________
Full payment must accompany your registration request.  Please make checks payable to: Sandusky Area YMCA 

Method of Payment (Circle one)    Check Enclosed    VISA     MC    DISCOVER

Card #_________________________________________________  Expiration Date: ____________________

Name as it appears on card: __________________________________________________________________

Signature: __________________________________________________________________________________

Waiver:  Please read and check the following before submitting this form.  Participant specifically assumes all risks of injury arising out of his / her presence of 
the Sandusky Area Young Men’s Christian Association (YMCA), my use of equipment or facilities and my participation in its activities, whether on its premises 
or at another location, and for myself and heirs and assigns hereby waive, release and agree to hold free from all claims for damages the YMCA and its offices, 
directors, members, employees, or agents.  I understand the risks and dangers involved in participating in the programs and activities of the YMCA, am physically 
capable of participating in such programs and agree not to participate in any activity that my injure myself or others.

 _____________________________________________________________________    ___________________________________     
                    Signature of Parent / Guardian                                                              Date 

 ______________________________________________________________________    ___________________________________ 
                      Signature of Adult Participant (18+)                                                         Date