BSY TORPEDOS SWIM TEAM - COMPETE IN THE FAST LANE - Central Connecticut Coast ...
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COMPETE
IN THE
FAST LANE
BSY TORPEDOS
SWIM TEAM
2021 LONG COURSE SEASON Registration Packet
"Shaping the mind, body, and spirit into a streamlined vessel built for enduring
success in life and the sport of competitive swimming." - BSY Mission
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.orgSTRATFORD YMCA BSY TORPEDOES SWIM TEAM
‘21 SHORT COURSE SEASON INFORMATION
Our team offers a stimulating, enjoyable program that stresses stroke technique,
starts, turns, and basic to advanced training. Our team ranges from recreational
swimmers to National Championship caliber swimmers – all are welcome and en-
couraged to swim with the BSY Torpedoes!
2021 Long Course Dates
• 4/26/21 through 7/30/2021
• Registration begins Monday, 4/5/2021
New swimmer evaluations will be held throughout the week around 5:00-5:30 at the Stratford
YMCA; new and interested swimmers must register for one of the days. Please be sure to reg-
ister for the evaluation with our membership service representatives.
For more information about registering/season details,
please contact our BSY Coaching Staff:
Oscar Rodriguez Stratford YMCA
orodriguez@cccymca.org 203-375-5844
Stratfordymca.org teamunify.com/ymca-0939
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.orgBSY Practice and Meet Information
It is great to have our full team safely back in the water. The
Stratford YMCA a special place and it is great to have you on our
team. We wanted to provide an update on how we anticipate the
short course season to evolve regarding practice and competition.
As the summer progresses, our primary focus will continue to be
the health and safety of our athletes and members. Any changes
to schedules and/or safety procedures will be well thought out and
communicated in advance. Our goal is to increase practice fre-
quency and/or duration for all groups over the coming weeks/
months. This will obviously be dependent on State of Connecticut,
CDC, and our Board of Health, Practice times may be extended or
additional days added. In the meantime, our coaches will continue
to provide supplemental training and dryland that athletes can do
away from the Stratford YMCA.
Kind Regards– BSY Coaching Staff
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.orgBSY TORPEDO PRACTICE SCHEDULE
Monday Tuesday Wednesday Thursday Friday Saturday
Eight and Unders
Blue 5:00-6:00 pm 5:00-6:00 pm 2:00-3:00pm
6:00-7:00
Purple 6:00-7:00 pm 6:00-7:00 pm 6:00-7:00 pm
pm
Age Groups (9 –12 years old)
5:00-6:00
Bronze 5:00-6:00 pm 5:00-6:00 pm
pm
6:30-7:30
Silver 6:30-7:30 pm 6:30-7:30 pm 6:30-7:30 pm
pm
3:45-5:00
Gold 3:45-5:00 pm 3:45-5:00 pm 3:45-5:00 pm 3:45-5:00 pm
pm
14 years old and Over
3:30-5:00
Senior 3:30-5:00 pm 3:30-5:00 pm 3:30-5:00 pm 3:30-5:00 pm
pm
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.orgBSY TORPEDO TRAINING GROUP DESCRIPTIONS AND FEES
Swimmers new to the program must be evaluated by a member of the coaching staff prior to enrollment.
8 & Under
Blue (Pre-Swim Team) ($90/month)
Swimmers in Blue Squad will be 8 Years Old or younger and practice three (3) times per week for 1 hour
learning how to better their stroke technique in all four competitive strokes, streamlining, basic
diving techniques in preparation for racing starts, and to learn the rules governing the competitive
strokes. Practice attendance is not required for this group, but it is recommended that swimmers
attend at least two out of the three practices each week.
Prerequisites:
• Ability to swim a continuous and legal 25 Yards/Meters of 2 out of the 4 competitive strokes
(Freestyle, Backstroke, Breaststroke, or Butterfly)
• Ability to Streamline underwater
• Ability to focus and follow instruction for 1 hour Understand and demonstrate the YMCA’s four
core character values of CARING- RESPECT- HONESTY- RESPONSIBILITY
Purple ($120/month)
Swimmers in Purple squad have four (4) one-hour practice sessions per week. Practice attendance is
not required for this group, but it is recommended that swimmers attend at least two out of the
four practices each week. Purple Squad swimmers will continue to learn the proper stroke technique
of all four competitive strokes, streamlines, racing starts and turns, how to use the pace clock and
the rules for competition.
Prerequisites:
• Demonstrate the ability to perform 50 Yards/Meters of all four competitive strokes with rea-
sonable and legal proficiency
• Demonstrate the ability to perform 100 Yards/Meters of 2 of the 4 competitive strokes
• Must be strong enough to handle 1 hour of training
• Must be able to focus for 1 hour of continuous learning
• Understand and demonstrate the YMCA's 4 core character values of CARING- RESPECT- HONES-
TY- RESPONSIBILITY
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.orgBSY TORPEDO TRAINING GROUP DESCRIPTIONS AND FEES
Age Groups (9-13)
Bronze (Pre-Swim Team Group) ($90/month)
Swimmers in the Bronze Squad have three (3) practices per week for one hour. Swimmers in this group begin to learn advanced
stroke technique, racing starts and turns, and basic training skills. Swimmers are introduced to basic race strategy and practice
sets.
Prerequisites:
• Ability to swim a continuous and legal 50 Yards/Meters of 2 out of the 4 competitive strokes (Freestyle, Back-
stroke, Breaststroke, or Butterfly)
• Ability to Streamline underwater
• Demonstrate a proven ability to listen to coaches and make effort to improve Understand and demonstrate the
YMCA's 4 core character values of CARINGRESPECT- HONESTY- RESPONSIBILITY
Silver ($130/month)
Swimmers in Silver squad have four (4) one-hour practice sessions per week. Practice attendance is not required for this group,
but it is recommended that swimmers attend at least two out of the four practices each week. Silver Squad swimmers will con-
tinue to learn the proper stroke technique of all four competitive strokes, streamlines, racing starts and turns, how to use the
pace clock and the rules for competition.
The Gold Squad is the top level of our Age Group Program. Practices range from one hour thirty minutes up to one hour forty-
five minutes in length.
Prerequisites:
• Swim a continuous 100 yard free with flip turns and streamlines.
• Swim a 100 IM
• Demonstrate a willingness to train and compete in all strokes/distances.
• Demonstrate a commitment to improving in the sport and consistent practice attendance habits
• Understand and demonstrate the YMCA’s 4 core character values of CARING- RESPECT- HONESTY- RESPONSIBILITY
Gold ($150/month)
Gold is designed to prepare the swimmers for the transition into our 14 & over programs. Swimmers in this group have five (5)
practices per week for one hour and 15 minutes. This squad is designed to offer an opportunity for 9 through 13-year-old
swimmers to continue their involvement with the Torpedoes. Training in this group will mirror the type of training being offered
to our Senior training squad.
Prerequisites:
• Swim a continuous 500 yard free with flip turns and streamlines.
• Swim a legal 200 IM
• Swim a legal 100 of all four competitive strokes.
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.orgBSY TORPEDO TRAINING GROUP DESCRIPTIONS AND FEES
14 to 18 year old
Senior ($170/month)
The Senior training group is our middle training group for 14 and overs and will have 5 regular practices a week. Training
emphasis will be aerobic in nature. However, there will be an increasing amount of specificity as the swimmers mature in
this group. The expectations of the training group are a minimum of 4-5 practices per week and a year-round commit-
ment to competition to experience consistent improvement.
• Swimmers in this group must understand and demonstrate the YMCA’s 4 Core Character values of CARING- RESPECT-
HONESTY-RESPONSIBILITY
How to Sign Up for Meets
• Register your email on https://www.teamunify.com/Home.jsp?team=ymca-0939. You will receive notifications on
new meets to enter into. After signing up, Oscar will enter child into the appropriate races.
• You will receive a confirmation that you have been entered into the meet. Due to the cost of registration and the
limited space, we ask that your child only signs up for meets that the swimmer is able to attend. In the event that
you are signed up for a meet and cannot attend, please notify Oscar by the Wednesday prior to the meet. It is
vital that you sign up for a meet before the registration deadline, as you will not be entered into the meet past
that deadline. There are no exceptions to this. Meet Etiquette Warm up is extremely important at swim meets for
the physical well-being and preparation of your swimmer, we ask that you make sure to have your swimmer on
deck 15 minutes prior to warm up. Coaches have to fill out an “attendance sheet” for the meet, called scratch
sheets, which are handed in during warm up. If a swimmer is not there on time, they will be scratched and no
longer able to compete in the meet. This is a USA swimming rule.
• If you are on your way to the meet and know you will be late, contact the Stratford YMCA who will inform the
coaches attending the meet. Your swimmer’s safety and well-being comes first to us, therefore if they are absent
from practice 3 consecutive days before a meet (without explanation), they are not prepared for the meet and
may not compete. Make sure your swimmer has towels (more than one), water, healthy snacks (no candy), gog-
gles, and a deck chair (this is optional, camping chairs are ideal). No electronics on deck! Be sure to bring extras,
especially towels and sweatshirts, so the swimmer will stay warm between races.
Tip: Keep spare clothes in a plastic bag, since everything gets wet at a meet! Meet Dress Code At meets swimmers
must wear their team suit and cap. If a cap/goggles breaks, someone will always be willing to share. On the pool
deck at a meet, team gear is encouraged. Final Tips Check the website daily. Any important announcements con-
cerning the team are posted on the website and will be relayed through the email system. Please make sure to
check these announcement regularly. Any questions please email Head Coach Oscar at bsyswimming@cccymca.org
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.orgBSY Torpedo Swim Team Registration Form
Participant’s First Name Middle Last Gender ___________
Address City State _______ Zip
Date of Birth ______________ ___ ____ Age entering program_________ Grade entering in Sept. _________ T-shirt size (Youth/Adult)
Parent # 1 Parent # 2
Home Address Home Address
Please Check Which Phone Number You Would Like Used As Primary Contact Number
□ Home Phone # ( ) □ Home Phone # ( )
□ Cell Phone # ( ) □ Cell Phone # ( )
□ Work Phone # ( ) □ Work Phone # ( )
Email Email
If parent cannot be reached, give name and relationship of person to be called in case of emergency.
Name: Relationship:
Home # ( ) Work # ( ) Cell # ( )
Does your child require special accommodations (social, behavioral, medicinal)? No_______ Yes_______
Parent/Guardian Permission: I hereby give permission for my child to participate in all activities that are part of the program. I understand there are risks
associated with activities and programs in which my child is a participant. I hold the Y Branch, the Central Connecticut Coast YMCA, its employees, representatives,
agents, and assigns from any and all claims whatsoever against said parties resulting from or caused by my child’s participation. I grant permission for any pictures
taken of my child while in the program to be used for publicity and promotional purposes.
Concussion Information: I have read the CDC Concussion Fact Sheet and will talk to my child about the information (http://www.cdc.gov/headsup/).
Guardian Authorization: In order to ensure the well-being of all our participants and our ability to help you with picking up your child, please include every
person that could assume the custody of your child for any unforeseen circumstances. The YMCA WILL require photo I.D. to release any child to an authorized pick up
person listed on this form. I authorize the YMCA to release my child to the custody of the following people other than me:
Name: __________________ Phone # ( ) ________ __________ Relationship________________________________
Name: __________________ Phone # ( ) ________ __________ Relationship________________________________
The YMCA is required to permit either parent to pick up the child unless the YMCA is furnished with a copy of a court order to the contrary. Please list below any
persons not authorized to pick-up this participant and attach a copy of the court order.
Name: ________________________________________________________________Relationship ____________________________________________
Name: ________________________________________________________________Relationship ____________________________________________
Authorization for Medical Attention: Please list all medications and/or medical conditions affecting your child. _____________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________
I give permission for the YMCA Certified First-Aid staff to treat my child, if needed. I authorize the aquatic staff to consent to emergency treatment (under advice
of a Connecticut licensed physician) for my child when the need for such treatment is immediate and when efforts to contact me are unsuccessful. My child will be transported to the nearest
emergency facility. I understand that any expenses incurred, through transportation and the treatment of my child, are my responsibility.
Name of Physician Address/Phone ______
Insurance Company Policy Number ______
Policy Holder Relationship to Child ______
• I understand that the Central Connecticut Coast Young Men’s Christian Association, Inc. (the “Parent Company”) and all of its branches are a charitable organization that makes its
programs and facilities available to persons only on the condition that they agree to assume full responsibility for injury and damage. Therefore in exchange for acceptance of the child
in the YMCA programs, I release, on behalf of the child, myself and members of the child’s family, the YMCA, the Parent Company, and officers, directors, employees and volunteers from
all claims of damage or loss to the child’s property and claims of personal injury or property damage caused to others by the child, including injury or damage to YMCA property or
personnel.
• I understand the financial requirements, registration, payment obligations and deadlines as outlined.
• I have read the above and agree to the terms and conditions.
Signature of Parent/Guardian Date _____
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.org2021 SHORT COURSE SEASON: April 26-July 30
Swimmer’s Name: _________________________________________________________________
Level (please check one)
Registration fee and first month is due upon registration– fees below is standard monthly rate; does not include $75 registration fee or financial assistance.
□ 8/Under, Bronze- $90 per month □ Age Group, Bronze - $90 per month □ Age Group, Gold- $150 per month
□ 8/Under, Purple- $120 per month □ Age Group, Silver- $130 per month □ Senior- $170 per month
MEET ENTRY FEES
Meet fees not included. Registration for meets registrations will be done through Team Unify and billed
automatically after each meet to your YMCA account.
SWIM TEAM PAYMENT OPTIONS AND AUTHORIZATIONS
Please check one:
□ Paying in full by (check one): □ Cash □ Check □ Credit Card on File at the Y
□ Paying in automatic monthly segments. The first segment is due at registration. All other segments will be due on the
first of the month, paid through an automatic draft. Please complete the automatic draft form below.
……………………………………………………………………………………………………………………………………………………………………..
I ________________________________________, hereby authorize the Central Connecticut Coast YMCA to charge the account listed on the 1st of
each month in the amount of $________to act as payment for the swim team. I understand that I must provide THIRTY DAYS notice, in
writing, if I wish to discontinue this service. This agreement is for the short course season only and the last draft will occur on July 1.
There will be a $20.00 charge for any EFT or charge returned by the bank. Also a $20.00 late payment fee will be added to the
account if not paid before the first of the month. These fees will be automatically drafted from my account. I understand it is my
responsibility to notify the YMCA of any change in address, bank account information (if utilizing bank draft for payment of child
care) or credit card information/expiration date (if utilizing credit card for payment of child care).
Please print your name ______________________________________Signature ___________________________________Date___________________
I authorize my bank to honor preauthorized Electronic Funds Transfers (or credit card charges) against my account for (swim team)
payments as indicated below. When the bank honors the EFT (or credit card) by charging my account, such transfer shall constitute
notice of payment due and my receipt for the payment. Should any preauthorized EFT (or credit card) not be honored by said bank
when received by them, then it is understood that the payment is to be made by me in the amount of said payment plus service
charge. It is further understood that if such payment is not honored by the bank (or credit card institution), then the YMCA, at its
discretion, may resubmit the amount due for payment on a future date.
□ I choose to utilize the EFT option for monthly payment (direct debit from my □ Checking □ Savings account)
Bank Name ____________________________________Name on Account__________________________________________________________
Routing Number ____________________________________________Account Number ______________________________________________________
Authorized Signature: ___________________________________________________________________Date: _______________________________________
□ I choose to utilize the Credit Card Payment option for monthly payment (automatic direct charge to credit
card) Credit Card Type □ American Express □ MC □ Visa
Card Holder Name __________________________________________________________Credit Card needs to be scanned at the branch.
Card Holder Address _________________________________________________________
□ Please use the current payment method currently on file with the Straford YMCA for monthly billing.
STRATFORD YMCA
Authorized Signature:
3045 Main Street, ____________________________________________Date:
Stratford, CT 06510 _________________________
P 203 375 5844 W stratfordymca.orgBSY Policies and Procdures CCC YMCA MISSION STATEMENT The Central Connecticut Coast YMCA is a charitable, not-for-profit, community service organization dedicated to putting Judeo-Christian principles into practice through programs that build healthy spirit, mind, and body for all. BSY VISION STATEMENT BSY is a swim program for all, dedicated to building a lifelong love for the sport of swimming. CENTRAL CONNECTICUT COAST YMCA MEMBER CODE OF CONDUCT Together, we can all do more to help strengthen our community. Toward that end, Central Connecticut Coast YMCA members should consistently celebrate the YMCA core values of caring, honesty, respect, and responsibility with behavior that illustrates those values. The Central Connecticut Coast YMCA reserves the right to suspend or terminate membership privileges for behavior not in accordance with our values. MEMBERSHIP Members of YMCA competitive teams must have full-privilege YMCA memberships. A swimmer must be a member in good standing at his/her YMCA for 30 days prior to competing for that YMCA in a meet. The swimmer must be a member in good standing of his/her YMCA for 90 days prior to representing that YMCA in a district, regional, state or national championship meet. Membership must last from the time of registration to the last day of the swim season. The membership will continue until you submit a termination request in writing with a 48-hour notice and only after your child completes their swim season. Please contact the Y for further details on membership prices, hours, and programs offered. COMMUNICATION Our primary methods of communication are via Team Unify and email. Please make sure your email is legible on page one of this packet. BSY Torpedoes Swim Coach Staff Email– bsyswimming@cccymca.org Go to our website, at www.teamunify.com/ymca-0939 VOLUNTEER AGREEMENT Each meet calls for many volunteers to ensure that the meet runs smoothly. Each family member (age 16+) will be assigned at least one timing shift. FINANCIAL ASSISTANCE Program financial assistance is available for qualified members through our Financial Assistance program, funded by the Annual Campaign. We are community-based and believe that our programs should be available for everyone. This confidential scholarship assistance application is available at Member Services and on-line at http://www.cccymca.org/ By signing below, you acknowledge that you have read, understand, and agree to the above. Signature of Parent/Guardian ___________________________________________________________________________________________________Date___________________________________________ STRATFORD YMCA 3045 Main Street, Stratford, CT 06510 P 203 375 5844 W stratfordymca.org
CURRENT DROP OFF/PICK UP (procedures subject to change based on updates in state and local guidelines) Please accompany your swimmer to the pool to ensure that they arrive on time and are prepared to practice. Make arrangements for pick-up at the end of your swimmer’s scheduled practice. All children under the age of 12 must be directly supervised by their parents or guardians while on Y property. All swimmers and family members entering the building must complete a health screening and temperature check. Masks are required in the common areas of the building. Spectators will not be allowed on the pool deck during practice and are asked to wait outside for pick up. Swimmers will be asked to enter the pool through the locker room and exit out of the main pool entrance door. See information update on attached sheet for more detailed information. TEAM UNIFORM The team swim suit is the Speedo Sapphire Lycra Flyback for girls, and the Speedo Sapphire Lycra Jammer for boys. The team swim cap is a royal blue custom BSY cap with your last name imprinted on it. The team warmup is the Speedo Streamline warm up jacket (sapphire) and pants (black). Contact Debbie Cosme at Metro Swim Shop at dcosmemetroswimshop@gmail.com to order your gear. A date will be scheduled for orders and sizing at the Stratford YMCA in September. USA SWIMMING USA Swimming memberships will be offered to most swimmers for the fall/winter short course season. By registering for USA, swimmers will compete in more meets and have multiple opportunities to improve their times. Meet entry fees are not included in the swim team fee. WITHDRAWAL FROM SWIM TEAM If at any time you need to remove your swimmer from the team, please fill out the appropriate form at Member Services and notify the coaches. Refunds for program fees will only be approved in the following instances: 1. The YMCA cancels a program. 2. Request form is received prior to the start of the session. 3. After the start of the session, only for medically documented reasons. There will be a $20.00 administrative fee for each refund or credit, unless the YMCA cancels the program. VIDEO RECORDER, CAMERA, AND CELL PHONE POLICY Turn it off. Use recording devices on mobile and cell phones, cameras, iPods, iPads, Tablets, MP3 players, video recorders, etc. is strictly prohibited. Video recorders, cameras, or any other visual recording devices are not allowed within the Y without the expressed consent of the Executive Director. Most cell phones have the capacity to take pictures and video, so be aware if someone has one pointed in your direction. Notify staff of any concerns. Report any one taking pictures of another person without their permission. PERSONAL BELONGINGS When it comes to bringing personal belongings into the Y locker rooms, remember it’s up to you to watch them and lock them. You are solely responsible for all personal belongings you bring and you must provide your own secure lock for protection of your items. Lockers are only to be used during normal operating hours. Unauthorized locks left overnight may be removed at the discretion of Y staff and the locker’s contents held for one week. After one week, the contents will be donated to charity. INSURANCE The Y does not provide health or accident insurance. The parent/guardian assumes total liability for all charges incurred for medical treatment or property damage. TEAM UNIFY The ability to communicate with your team is essential to your team’s success. Team unify is the BSY Torpedoes official website and informational page. This site is used to for coaches to deliver BSY information and updates to parents. With TeamUnify, not only do you get email, SMS and push notifications, but they are connected to your team’s accounts, athletes, and even billing groups, locations, and rosters, allowing you to send direct messaging to the right groups simply and effectively. Please be sure to leave correct contact information (email and cell phone) during registration. All new BSY swimmers will be sent a Team unify invite after registering. https://www.teamunify.com/Home.jsp?team=ymca-0939 By signing below, you acknowledge that you have read, understand, and agree to the above. Signature of Parent/Guardian ___________________________________________________________________________________________________Date___________________________________________ STRATFORD YMCA 3045 Main Street, Stratford, CT 06510 P 203 375 5844 W stratfordymca.org
1. The health and safety of our swimmers and community is our first priority.
2. The Stratford Y is asking all individuals to answer Health Questions prior to entering the Y.
Based on answers, swimmers may able to participate. Please contact us for a current question-
naire.
3. The most concerning threat to an organized sports team is rapid spread within the group.
Effective containment depends on early symptom identification, removal from practice
(isolation), and strict guidelines regarding return to practice.
4. If you have a fever or any flu symptoms (which may include but are not limited to, Unex-
plained rash, Diarrhea, Vomiting, Cough, Shortness of breath/difficulty breathing, Fever, Chills,
Muscle pain or body aches, Sore throat, New loss of taste or smell.) in the past 24
hours, please remain at home and do not return to practice until you are unmedicated and
symptom free for 72 hours. If practical, contact your doctor.
Contact the Y immediately, if a swimmer or a swimmer’s immediate household member has test-
ed positive for COVID-19 or otherwise been diagnosed with COVID-19. The Y has health and
safety protocols that will be met in the event of a positive case.
ADDITIONAL SAFETY EXPECTATIONS
• All safety measures are subject to change per State of CT, Governor Lamont, Health Depart-
ment or YMCA needs.
• The safety expectations will be taken directly from the summer camp safety plan. To view
the policies and procedures our swim team will be following, please use the link below for
more information.
https://cccymca.org/wp-content/uploads/CCCY-2021-Day-Camp-Safety-Plan-1-1.pdf
• Any additional updates and changes to our policies and procedures will be communicated
through our swim teams web page at:
https://www.teamunify.com/AlertCenter.jsp?team=ymca-0939
STRATFORD YMCA
3045 Main Street, Stratford, CT 06510
P 203 375 5844 W stratfordymca.orgCENTRAL CONNECTICUT COAST YMCA Minor Participant Waiver, Release, Indemnification of All Claims & Covenant Not to Sue PLEASE READ CARFULLY. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS AND IS LEGALLY BINDING. BY SIGNING THIS AGREEMENT YOU ARE RELEASING CENTRAL CONNECTICUT COAST YMCA INC. FROM ALL LIABILITY AND FOREVER GIVING UP ANY CLAIMS THEREFORE Assumption of Risk I, in my legal capacity as parent/guardian of the minor named below (“Minor”), acknowledge and agree that any use of Central Connecticut Coast YMCA Inc. facilities, services, equipment and premises (“Facilities”) and any participation in Central Connecticut Coast YMCA Inc. programs and activities (“Programs”) comes with inherent risks including, but in no way limited to: (1) moderate and severe personal injury, (2) property damage, (3) dis- ability, (4) death, and (5) sickness or disease. I voluntarily, for myself and Minor, accept and assume full re- sponsibility for these risks as well as any and all other risks of the use of Facilities and participation in Programs. I agree that I have full knowledge of the nature and extent of all such risks and am not relying on all such risks being described in this document. Waiver, Release, Indemnification & Covenant Not to Sue In consideration of Minor’s use of Facilities and participation in Programs I, in my legal capacity as parent/ guardian of Minor, agree on behalf of myself and Minor that Central Connecticut Coast YMCA Inc., its officers, directors, agents, employees, volunteers, insurers and representatives (“Releasees”) will not be liable for any personal injury, property damage, disability, death, sickness or disease incurred by Minor, however occurring including, but not limited to, the negligence of Releasees. I understand that Minor and I will be solely responsi- ble for any loss or damage, including personal injury, property damage, disability, death, sickness or disease sustained from the use of Facilities and participation in Programs. I further agree, in my legal capacity as the parent/guardian of Minor, on behalf of Minor, myself, and any and all legal successors and proxies, to release and HEREBY DO RELEASE, WAIVE AND COVENANT NOT TO SUE Releasees from any causes of action, claims, suits, liabilities or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which Minor, myself, and any and all legal successors and proxies may have, now or in the future, against Releasees on account of personal injury, property damage, disability, death, sickness, disease or accident of any kind, arising out of or in any way related to the use of Facilities or participation in Programs, whether that participation is supervised or unsupervised, however the injury or dam- age occurs, including, but not limited to, the negligence of Releasees. In further consideration of the use of Facilities and participation in Programs, I, in my legal capacity as parent/ guardian of Minor, agree on behalf of myself and Minor to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, suits, liabilities or costs of any nature whatsoever, includ- ing claims of negligence, arising out of or in any way related to the use of Facilities and participation in Pro- grams. Minor Name (Print Clearly) Parent/Guardian Signature Parent/Guardian Name (Print Clearly) Date STRATFORD YMCA 3045 Main Street, Stratford, CT 06510 P 203 375 5844 W stratfordymca.org
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