Snorkel with Santa Registration

Thank you for your support with our event!  We look forward to seeing you at Snorkel with Santa.

If you have any questions please contact Tara at 607-772-0560 ext. 140

 

Child's Name
What is your child's age?
Gender
 Male  Female
 
Child's Name
What is your child's age?
Gender
 Male  Female
 
Child's Name
What is your child's age?
Gender
 Male  Female
 
Child's Name
What is your child's age?
Gender
 Male  Female
 
Name of parent/guardian's
Address
City
Email
Phone
Are you a Y member?
 Yes  No
 
How did you hear about this event?
I give permission for the YMCA to use images of my child for internal and external promotional materials. This includes any printed material, broadcast and print advertising, promotional videos and the YMCA Web site which are produced or published by the YMCA. I also permit the YMCA and/or the media to use images of my child in broadcast and print media news coverage of the YMCA. I understand that my child’s name is not published.