INFORMED CONSENT/LIABILITY WAIVER AGREEMENT:
I/We, the undersigned, realize that there may be medical risks associated with physical exercise, the use of this facility, or use of
equipment within the facility. I/We also recognize that the YMCA cannot evaluate my/our physical abilities and medical limitations
as they pertain to participation in programs, to use the facilities, or use of equipment within the facility. I/WE THEREFORE ASSUME
ALL RESPONSIBILITY FOR HAVING A THOROUGH MEDICAL EXAMINATION PERFORMED, BY A MEDICAL PRACTICIONER OF MY/OUR
CHOICE, BEFORE PARTICIPATING IN ANY PROGRAMS AND PRIOR TO USING THE FACILITIES OR EQUIPMENT WITHIN YMCA
Furthermore, in consideration of my/our participation in the activities of the YMCA and its respective officers, employees and
members, including but not limited to its or their own negligence, and do hereby for myself/ourselves, heirs, executors and
administrators, waive, release and forever discharge any and all rights and claims for damages which I/We may have or which may
hereafter accrue to me arising out of or connected with my participation in any of the activities of the YMCA, use of its facilities,
or use of equipment within its facilities; provided, however, that the hold harmless agreement, and waiver, release and discharge
contained in this paragraph shall not apply to my/our participation in any of YMCA’s childcare services.
By participating in the YMCA Nationwide Membership Program, I agree to release the National Council of YMCAs of the United
States of America, and its independent and autonomous member associations in the United States and Puerto Rico, from claims of
negligence for bodily injury or death in connection with the use of YMCA facilities, and from any liability for other claims, including
loss of property, to the fullest extent of the law.
I consent to the taking and use of still photography and/or motion pictures of me or my family for use of magazines,
television, newspapers, etc. and to the non-commercial use of such photographs or motion pictures. I understand that
the YMCA has no control over and is not responsible for the content in such publications and broadcasts.
I hereby waive payment or royalties for the exhibition or showing of photographs or motion pictures and/or the use of
information provided by me. The YMCA will post signs when professional photographers or TV crews are on site so members
have the option to avoid their images being utilized.
TERMS AND CONDITIONS:
The YMCA conducts regular sex offender screenings on all members, participants, and guests. If a sex offender match occurs, the
YMCA reserves the right to cancel membership, end program participation, and remove visitation access.
I agree to abide by the rules and regulations of the YMCA, which are designed for the enjoyment of all its members. The protection
of members and guests who are utilizing the YMCA is of paramount concern to the YMCA. We reserve the right to deny access of
membership to any person whose behavior is determined to be in conflict with the welfare and safety of other members and/or
staff. This includes a person who is a registered sexual offender; has plead guilty to or been convicted of any crime involving sexual
abuse; or a crime against persons such as a child, spousal or parental abuse. It will also include any offense related to the sale or
transportation of illegal, habit forming or dangerous drugs; is presently clearly under the influence of intoxicating beverages or
behavior modifying drugs. This code of conduct does not permit language or any action that can hurt or frighten another person or
that falls below a generally accepted standard of conduct. This includes inappropriate attire, angry or vulgar language, physical
contact with another person in an angry or threatening way, any demonstration of sexual contact or activity, harassment or
intimidation by words, gestures, body language or any other menacing behavior, theft or behavior resulting in destruction of
property. Parents are held responsible for the behavior of their children.
ELECTRONIC PAYMENT AUTHORIZATION AGREEMENT:
I hereby authorize the Philadelphia Freedom Valley YMCA, to initiate debits to the bank/credit cards which I add to my account.
I agree to notify the Y about any credit cards reported stolen, expiration date changes and address changes. I also agree to notify the Y 10 days prior to the month of the draft to allow for processing time.
If there is an error in my debit, I will notify the Y within 30 days of the transaction date. The transaction will be investigated.
If my EFT or Credit card draft is declined for non-sufficient funds (NSF), the payment may be collected electronically (by a third party) and a NSF fee of up to $35 per incident may be applied.
Changes to your checking or savings account will require 30 days to authorize the account to charge future withdrawals.
I understand that Y memberships are continuous and rates may increase annually on January 1st.
I understand that any discount applied to my membership is only good for one year and that I must re-apply to renew the discount at least 30 days prior to loss of eligibility. Otherwise the membership may continue at the FULL RATE.
The Y processes monthly Membership payments on the 1st and/or 15th of every month (or next business day). If we cannot process your draft we will resubmit for payment.
YMCA membership will automatically be adjusted at these specific ages: 13, 19, and 65 years old.
The Y reserves the right to cancel/terminate any membership/program if a payment cannot be collected.
The Y processes Program Fee payments by varying program dates and can be processed at any regularly scheduled interval. If we are unable to draft your Program Fee payments for any reason, we will automatically redraft on our next scheduled draft date. Please ask for a specific Program Draft Schedule when registering for a Program Automatic Draft.
I understand that my membership may be terminated at any time. This must be done in person by signing the appropriate cancellation form. NOTE: THE YMCA WILL NOT ACCEPT PHONE OR FAX CANCELLATIONS AT ANY BRANCH. I understand that I must give 30 days notice to stop my bank/credit card draft.
I, the undersigned, have read, understand and agree to the above.