Thanks to our generous donors, financial assistance may be available to families who qualify
Southwest YMCA
Scholarship Application Form Download |
Player Name:
(required)
I've played Y Football before # of seasons |
DOB
(required)
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Choose One:
(required)MaleFemale |
Phone:
(required)
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| Street Address: (required)
Is this a new address? YesNo |
Grade in Sept. 2008
(required)
School Name
(required)
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City
(required)
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Zip Code
(required)
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School
(If private school: would you prefer placement by school or residence area - please choose one) |
Father's Name:
(required)
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Work Phone: |
Employer / Title: |
Mother's Name:
(required)
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Work Phone: |
Employer / Title: |
| Email Address |
Emergency Contact/Phone:
(madatory)
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Fax/Cell Phone |
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Submit this online form by clicking the "Submit" button below
Please choose one: Visa Mastercard Discover Americanexpress
Online registration won't be processed without credit card payment
No execptions! |
| Enter your credit card numbers below then click the "-->" button on the right to encrypt your credit card serial numbers prior to submitting this online form. |
FOR EXTRA PROTECTION, PLEASE FOLLOW THE DIRECTION ON THE LEFT PRIOR TO SUBMISSION
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Enter Credit Card Serial Numbers
(mandatory)
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Encrypted Information to be sent
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Expiration Date
(mandatory)
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I, on behalf of myself (as a parent, guardian, coach, aide spectator, or participant) hereby; release the YMCA, its directors, officers, employees and volunteers (collectively “Releases”) from all liability to me for any loss or damage to property or injury or death. I agree not to sue Releases for any loss, damage, injury or death. I give the minor permission to participate in the YMCA program, and the minor is physically and mentally prepared to participate in all program activities. I give the YMCA permission to use mine or my child’s picture or other likenesses in any of the YMCA’s general publicity and campaign materials.
(Mandatory Legal Guardian/Parent Acknowledgement)AgreeDisagree |
| On YMCA mail list? Yes No |
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