Pool Tournament

Pool Championship

The program application must be completed by a parent/guardian.
It’s game time! Teens will compete in friendly yet exciting matches, showing off their aim, strategy, and trick shots. Whether you’re a rising 8-Ball pro or just here for the fun, it’s your chance to rack ‘em up, sink some shots, and see who comes out on top. Prizes, bragging rights, and a whole lot of fun await! This tournament is open and available to all!

Tournament Details:
Date: Wednesday, April 22nd
Time: 3:45 PM
Location: Summit YMCA Teen Center
STUDENT INFORMATION
Student Name

First NameLast Name
Student Date of Birth

MonthDayYear
Student Email
example@example.com
Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Gender

Other
School Name
Grade
Please note: Y-USA requests the above information from YMCA participants throughout the nation for program funding and demographic purposes.
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name

First NameLast Name
Relationship to Student
Parent/Guardian Date of Birth

MonthDayYear
Parent/Guardian Phone Number
Format: 000-000-0000.
Parent/Guardian Email
example@example.com
Address (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT INFORMATION
Do you want to provide Emergency Contact information for the student that is different from the Parent/Guardian information provided above?
Name

First NameLast Name
Relationship to Student
Phone Number
Format: 000-000-0000.
Address (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Code of Conduct Agreement
Waiver & Release of Liability
Please confirm you are not a robot
Student Signature

Clear
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Pool Championship