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This is a great opportunity for your kids to become familiar with different sports. Children will have fun and learn the basic skills of basketball, soccer, and floor hockey. Parent participation is required.

Time: 6:00pm - 6:45pm Cost: $30/Member $50/Program Member *Registration deadline is 5 days prior to event! **Additional $5 after deadline. ***Minimum of 8 participants to host program. Basketball

Dates: Location: Dates: Location: Dates Location: Thursdays, January 12 - February 23 YMCA Gymnasium

Basketball - Floor Hockey - Soccer

AGES 3-5

Floor Hockey

Thursdays, March 1 - April 12 YMCA Gymnasium


Wednesdays, April 25 - June 6 Hugh Parker Soccer Complex

Shiawassee Family YMCA

515 W. Main St, Owosso


Floor Hockey ____

Soccer ____

Pee Wee Sports 2012 - Basketball ____

Name: ____________________________________ Age: _____ D.O.B. _______________ Address: ______________________________ City: ________________ Zip: ____________ Phone: _______________________ Email Address: _________________________________ Mother's Name __________________________ Father's Name ________________________ Emergency Contact: _______________________________ Phone: _____________________ Shirt Size: 6/8 10/12 14/16

The Shiawassee Family YMCA requests consent to release photographs, slides, moving pictures and audio/visual tapes of the above named minor child for the purpose of YMCA records, public relations and/or advertising, videos, voice or text material and either with or without my or my child's name or photo accompanying quotation. Parent/Guardian Signature: __________________________________________________ Date: ___________________ I do hereby stipulate and agree to indemnify and to hold forever harmless the Shiawassee Family YMCA against any and all claims arising from my own or my child's participation in the YMCA programs or activities. Parent/Guardian Signature: __________________________________________________ Date: ___________________ Staff Use Only $ _____ Paid by: Cash Check Charge Date: _____________ Staff: _____________________


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