Att Kids Day

Serving those that serve America

Youth & Community Outreach Programs

AT&T Kids Day at the Ballpark A FREE trip for military kids for a great afternoon at PETCO Park!

Thursday, July 2nd Drop off: 10:00 a.m.

Pick up: 4:30 p.m.

3293 Santo Road San Diego 92124 - Playground

Kids 10-15 years: Military kids cheer on the San Diego Padres at the annual AT&T Kids Day at the Ballpark. Tickets, transportation, lunch, and a t-shirt are all provided. For more information on Youth Summer Programs visit www.militaryymca.org Complete and return BOTH the registration and liability forms to 3293 Santo Road San Diego 92124 Forms are also available at the Armed Services YMCA office from 8:30 a.m. to 4:00 p.m.

AT&T Kids Day at the Ballpark REGISTRATION FORM Child Name: ___________________________________ Gender: _______Age: _______ Active Duty Sponsor Name:________________________ Branch: __________ Rank: _______ Parent/Guardian Signature:_________________________________ Date: _______

Interested in being a Parent Chaperone?: YES/NO

Special thanks to AT&T! San Diego Armed Services YMCA

Visit our website www.militaryymca.com for more information on

3293 Santo Road, San Diego, CA 92124

the over 40 free programs and services available to your family!

Youth and Community Outreach Department Release of Liability Form: Adults and Minors

Parent/Guardian Name(s) (print)______________________________________________________________________ Parents Date(s) of Birth (same order)__________________________________________________________________ Address________________________________City_________________Zip____________Military Housing? Yes/NO Email Address________________________________________Service Branch_____________________Rank______ Home Phone__________________________Work__________________________Cell__________________________ Emergency Contact________________________________________________________________________________ EC Home Phone_______________________EC Work_______________________EC Cell_______________________ Minor Children Participating: Name______________________________________________________________Date of Birth___________________ Name______________________________________________________________Date of Birth___________________ Name______________________________________________________________Date of Birth___________________ Activity or Group____________________________________________________Date(s)________________________ Location_________________________________________________________________________________________

I, the undersigned parent/person having legal custody/guardianship of the above said minor, give permission for the minor to participate in the San Diego Armed Services YMCA program described above. The minor is physically able and mentally prepared to participate in all activities as described in the announcement for the program. I hereby voluntarily and knowingly assume all risks and dangers inherent and incidental to the activities of the program. I will not hold the San Diego Armed Service YMCA liable for any injuries incurred during the program or while my child(ren) is/are in transit to and from the program whether caused by equipment or the act or omissions of others excepting damage or injury solely caused by the willful misconduct or negligence of the San Diego Armed Services YMCA, or its employees, volunteers, or agents. I do hereby authorize the San Diego Armed Services YMCA as agent for the undersigned, to consent with respect to the minors, to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under general or special supervision of, any physician and surgeon licensed under the provisions of the California Medical Practice Act on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. I understand that the San Diego Armed Services YMCA is not responsible for costs incurred for medical care. If I participate in the program, whether as coach, instructor, aide, spectator, or participant, I presently waive as to the San Diego Armed Services YMCA and staff, officers and directors thereof, any claim presently known or unknown for damage to property or personal injury whether caused by equipment or the acts or omissions of others including San Diego Armed Services YMCA personnel. My Child(ren) will _____ Walk Home _____Be picked up. Person(s) who may pick up child(ren)____________________ _______YES My child(ren) can receive a healthy snack

_______NO My child(ren) cannot receive a healthy snack

Food Allergies, if any:______________________________________________________________________________

****Parent/Guardian (Signature)____________________________________Date___________________**** I hereby grant full permission for my child and/or myself to be photographed by the San Diego Armed Services YMCA staff for any legitimate purpose without payment or compensation.

****Parent/Guardian (Signature)____________________________________Date___________________****