Central Bucks Family YMCA Waiver
Cold Spring 6th Grade Night @ the Y

Child’s Name ________________________________________________________
Child’s Address ______________________________________________________
Child’s DOB ______________ Phone Number ___________________________
Email Address _______________________________________________________

In consideration of my child’s participation in the activities at the Central Bucks Family YMCA, I do hereby hold the CBFYMCA free from any liability, including their respective officers, employees and members. This includes, but is not limited to, their own negligence. I do hereby -- for myself, heirs, executors and administrators -- waive, release and forever discharge any and all rights and claims for damages or injuries which my child/I may incur or may arise in connection with participation in any of the activities within the facility. I, the undersigned, have read, understand and agree to the above. My consent to the terms is assumed if I do not return this form.

Signature __________________________________________________________