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Healthy Team On-Line Registration Form

Deadline for online submission is February 20. You must also contact Karen Backus (203 736-1435 x316) at the Valley YMCA to schedule your pre-test.

For your convenience, you may submit this on-line registration form by filling out the information and clicking below. Click here for more information about Corporate Cup Healthy Team. Click here for a printable version of the Physician's Consent Form.
 

If you are already registered through the full Corporate Cup Registration, use this form to submit your roster or additional teams. You may also use this form to register for this event only if you have not registered for the full Corporate Cup package. 

Registration Form:
This is:
the Healthy Team entry part of a full Corporate Cup registration
an individual Healthy Team event entry

Team Name:  
Organization:  
Address 1:  
Address 2:  
City: State: Zip:  


Contact Person:
Name:  
Work Phone:   Home Phone:  

E-mail Address:  

Please use the space below to fill in the names of your players. Your team of must include two players. Signatures will be required on the day of competition along with a doctor's approval.

.  
 

Entrance Fees The Healthy Team entrance fee is $75 per team. Simply complete this form and submit it for each additional team. Payment is due at the Y before the event. Please mail to: Candase Dunn Valley YMCA 12 State Street Ansonia, CT 06401 If you took advantage of the full Corporate Cup registration, your first team is covered in the registration fee.

   

You will be contacted within 48 hours to confirm your registration.

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Building a healthier life style