In am effort to improve our organization, we ask you to answer the following questions.

1. How did you find out about AYA registration?

( ) Yellow Sign ( ) Flyer from School ( ) Flyer in Mail ( ) Newspaper ( ) Friend ( ) Other

2. Is this our first season at AYA? ( ) Yes ( ) No

3. If YES, what is the primary reason you have chosen AYA? ______________________________________

4. If NO, what is the one improvement at AYA that you would most like to see? _______________________

5. How are you willing to help make that improvement? __________________________________________

PLEASE READ CAREFULLY !!!!

As the parent or legal guardian of the child/children named on the reverse side of this form, I, the undersigned do hereby give my consent and approval of said child/children to participate in all AYA activities. I agree to abide by all AYA rules and regulations and to support the highest standards of teamwork and good sportsmanship at all AYA functions. I understand that REGISTRATION FEES ARE DUE AT THE TIME OF REGISTRATION. I further understand that registration and sponsor fees do not fully cover the cost of providing a program for my child and that I/we will be required to participate in one of the designated fundraising options. I understand the fundraising options are limited to either a $45, per child, tax deductible donation to AYA or I can accept the fundraising materials ( a $100 value ) from AYA and be responsible for FULL PAYMENT OF ALL FUNDRAISER FUNDS TO AYA ON OR BEFORE THE SPECIFIED DATE. AYA may use images, of any child/children, without name identification for the sole purpose of promoting the AYA programs in it’s website, flyers or any other promotional materials.

Absolutely NO REFUNDS of registration fees, sponsorship fees, or fundraiser obligations will be made without a ruling from the AYA Board of Directors. Only cases involving injury, debilitating disease, or unforeseen relocation to an area outside a reasonable proximity to AYA, as determined by the AYA Board, will be reviewed for possible refund.

I have read and agree to the foregoing and understand that this is a legally binding agreement.

Signature ________________________________ Printed Name ___________________________ Date _____________

INDEMNIFICATION AGREEMENT

I, the undersigned do hereby attest that I/we are the legal guardian(s) of the child/children named on the reverse side of this form. I/we understand that participation in organized sports can result in serious personal injury and do hereby give my consent and approval to his/her/their participation in any and all activities for the current season. I/we also assume all the risks and hazards incidental to the conduct of the activities and hereby agree to the maximum extent permitted by applicable law, to release, absolve, indemnify, hold harmless and defend at my/our own expense, the Alief Youth Association, it’s representatives, volunteers and assigned agents from any and all claims arising out of injury to, disease or death of , or damage to or the loss of property, of my/our child(ren), myself, friends, relatives or any other persons whom I/we should cause to participate in and/or spectate at any Alief Youth Association sponsored activity, whether by invitation or notification of the existence of said activities, even though caused by the sole, concurrent or contributory, active or passive or of any kind of description or fault or a party indemnified.

BY AFFIXING MY SIGNATURE BELOW, I ATTEST TO HAVING READ, UNDERSTOOD AND AGREE TO THE INDEMNIFICATION AGREEMENT ABOVE.

Father’s Signature __________________________________________ Date ___________________________________

Mother’s Signature __________________________________________Date ___________________________________

Legal Guardian’s Signature ___________________________________ Date ___________________________________