Program Registration Packet

Registration Checklist
r Review Program Info Sheet (if one is available) (1 of 4)
r Complete Household Registration Form (2 of 4)
r Complete Consent Waiver Form (3 of 4)
r Complete Program Registration Form (4 of 4)
 Cherokee Outdoor
Family YMCA
Contacts:
Sports Director
Jan Samuel
jans@ymcaatlanta.org
Youth Sports
Monica Knittel
monicak@ymcaatlanta.org
Game Schedules
Quickscores.com/cherokeeoutdoorymca
Field/Weather Hotline
770-908-3463
Membership:
Participation requires either a program or
facility membership. Membership is good
for one year for your family household
from the date of purchase. You may
choose from the following:
$35 - Family Program Membership
(Families enjoy playground, fishing pier,
hiking trails, sign up for YMCA programs)
OR
Family Facility Membership
Contact the YMCA facility of your choice.
Open Registration:
Jan. 1st - Jan. 30th
• New Places to Register!!!
• Two convenient locations see
addresses below
• Download forms from
CherokeeYMCAregistration.com
OR
• Please mail or fax.
• Payment required at registration to
reserve child’s spot.
• Players signing up during open
registration will be assigned to
teams needing players.
!
151 Waleska Street, Canton, GA 30114
Phone: 770-345-9622 Fax: 770-345-5290
Hours: 9-8pm Mon-Fri/9-5pm Sat/1-5pm Sun
Age Divisions:
League Birthdates
U-4…………..9/01/04 - 8/31/06
U-5…………..9/01/03 - 8/31/05
U-6…………..9/01/02 - 8/31/04
U-7…………..9/01/01 - 8/31/03
U-8…………..9/01/00 - 8/31/02
U-10……..…..9/01/98 - 8/31/00
U-12……..…..9/01/96 - 8/31/98
U-14…………9/01/94 - 8/31/96
Important Dates:
Jan. 1st - Jan. 30th…………………….Open Registration
Feb. 2nd- Feb. 13th…………………….Late Registration ($15 late fee applied)
Feb. 9th - Feb. 13th………………...….MANDATORY Coach’s Meetings
February 14th………………………….Coach’s Training (with British Soccer)
Feb. 23rd - Feb. 27th……………….….First Week of Practices
February 28th…………………………..Meet & Greet (U-4, U-5, U-6 ONLY)
March 7th………………………...…….First Game
May 2nd………………………..……….Last Game
ABSOLUTELY NO REGISTRATIONS WILL BE ACCEPTED AFTER FEBRUARY 13th!
No Practices & Games during the week of Cherokee County School
Breaks.
Leagues U4 thru U10 will be playing at
All players need a soccer ball, water the Cherokee Outdoor YMCA, unless
bottle, shin guards, and cleats for prac- otherwise noted on your registration
tices and games. We will only provide form. The other option for U4 thru U10
socks for U10, U12, and U14 leagues . is to play at JJ Biello Park (off of Arnold
Mill Rd.) We have also added U4 thru
Appropriate ball sizes: U6 league at Weatherby Park to serve
U4 thru U8: Size 3 the Canton/Waleska area. The U12 &
U10: Size 4 U14 teams will be playing at Johnston
U12 thru U14: Size 5 Elementary School. Leagues may be
combined as necessary if there aren’t
enough players, or they may be moved
to the YMCA location.
U4, U5, and U6 leagues will practice &
play on Saturdays ONLY. Leagues U7
thru U14 will have one practice during
the week and a game on Saturdays. Ages range from 3 to 13.
Make up games on Sundays. See All teams are coed.
above for exact dates.
201 East Bells Ferry Rd., Woodstock, GA 30189
Phone: 770-591-5820 Fax 770-345-5290
Hours: 9-5 Mon- Fri
 METRO ATLANTA YMCA
RELEASE, INFORMED CONSENT & WAIVER AGREEMENT FOR
MEMBERS, GUESTS AND PROGRAM PARTICIPANTS
Form updated 1/15/08

OUR PROMISE TO YOU

The Metro Atlanta YMCA endeavors to provide a safe environment and programs for you, your family and guests. The YMCA provides exciting, life-
changing programs that involve exercise, travel, learning, and sports. These programs have a certain amount of risk associated with them. This form
is to make you aware of those risks and to ask that you assume certain responsibilities for your decisions and actions.

FOR YOUR HEALTH

• I understand I am engaging voluntarily in YMCA exercise, physical activity and/or recreational programs.

• It is my responsibility to monitor my own condition throughout any activity or program and, should any unusual symptoms occur, I will cease my
participation and inform the instructor and/or staff of the symptoms.

• In the event that a medical clearance must be obtained prior to my participation in a physical activity program, I agree to consult my physician
and obtain written permission from my physician prior to the commencement of any program. I agree to assume the natural risks associated with
exercise and physical activity.
FOR YOUR SECURITY
• I understand the YMCA parking lot and locker rooms are provided for members’ and guests’ convenience while using the facility. The YMCA is not
responsible for vandalism, break-ins or thefts of personal property. I understand the YMCA recommends that valuables should not be brought onto
the premises. I agree to report any suspicious activity immediately to the YMCA.

REGARDING YOUR CONDUCT

• I will not bring weapons, controlled substances or alcohol on YMCA premises.

• I understand that use of violence, noise, force, coercion, sexual misconduct, threats, intimidation, unsafe conduct regarding children, fear,
resistance, insults, or other conduct, intentionally or unintentionally causing disruption or preventing YMCA members’ ability to enjoy their
membership or YMCA staff’s and/or volunteer’s ability to conduct class or their job duties, is not acceptable behavior, is in conflict with YMCA
values, and may result in the termination of my membership. I am aware that the YMCA reserves the right, within its sole discretion, to withdraw
membership privileges to anyone for any reason that the YMCA, in its sole discretion, considers appropriate or in the interests of the YMCA and/or
its members.
YOUR CONSENT AND RELEASE
• I HEREBY AGREE TO RELEASE AND HOLD HARMLESS the YMCA, its employees and volunteers, from any loss, liability, claim of bodily injury or
property damage, or costs which may arise due to my use of the YMCA’s facilities and equipment and my participation in YMCA programs. This
agreement shall be governed by the laws of Georgia.

• I authorize the use and reproduction of any and all photographs or video footage for YMCA promotional purposes without compensation, and I
understand that it is the personal responsibility of members and their guest(s) to avoid being photographed if they so desire.

• By signing this form, I agree that I have read this entire form and understand my responsibilities for participation and conduct in YMCA programs
and activities.

_______________________________________________________________________________________________________
Signature Name (Please Print) Date

_______________________________________________________________________________________________________
Spouse (if family membership) Date

_______________________________________________________________________________________________________
Name(s) of Child/Children

_______________________________________________________________________________________________________
Parent/Guardian Date

_______________________________________________________________________________________________________
Emergency Contact/Relationship Home Phone # Cell Phone #
 Cherokee Outdoor
Family YMCA

Player Info:
Player’s LAST Name:________________________________________ FIRST Name:________________________
(Circle) Male / Female DOB: ____/____/____ Age: ______
Email: ______________________________________(for contact only)
Mom: ______________________________________Cell Phone: (_____)____________________
Dad: _______________________________________ Cell Phone: (_____)____________________

(Circle) Player’s Shirt Size : YXS YS YM YL AS AM AL (“Y” indicates youth sizes, “A” indicates adult sizes)

(Circle) League child is to play in: (If unsure, see front page)

U-4 U-5 U-6 U-7 U-8 U-10 U-12 U-14 U-6 U-10 U-4 U-5 U-6
YMCA Johnston Elementary JJ Beillo Riverside Weatherby Park

Special Requests: Volunteer Opportunities:

Coach Request: __________________________ Please note that we Get involved and help make
will do our best to fulfill
Player Request: __________________________ your requests, but they a difference at your YMCA!
are not always guaran-
If applicable, day you CANNOT practice: M T W TH Circle the Following:
Head Coach
(organize team, conduct
Registration Fees: practices, attend games)
League: U-4, U-5, U-6 U-7, U-8 U-10, U-12, U-14 Assistant Coach
(assist head coach
Registration Fee:
*Program Member Price * $90 * $100 * $115 with preparation and play)
Shirt Size: S M L XL XXL
What is included in Team T-Shirt & Soccer Jersey & Soccer Jersey, Socks, &
Registration Fee? Trophy Trophy Trophy Preferred Practice Day:
(Circle at least 2 choices)
*If you are a Facility Member at another YMCA, you can subtract $15 from the above price. At M T W TH F
the Cherokee Outdoor YMCA, if you paid $275 for your membership and are able to use our
pool, then you are considered a Facility Member. All others are Program Members. Are you? Dad Mom

Amount Due:
Registration Fee: $________ Membership: $__________ Late Fee: $__________
(see front page for membership info) (If after 1/30/09)
Total: $___________
(Circle) Method of Payment: Cash Check Card (Circle) Visa Mastercard Discover American Express
Card #: ____________________________ Exp Date: ____/____

Check List Did you complete each one of these?

Membership Application (Even if your membership is current)
Waiver
Soccer registration form
Payment