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 the use of 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 PRACTITIONER OF MY/OUR CHOICE, BEFORE PARTICIPATING IN ANY PROGRAMS AND PRIOR TO USING THE FACILITIES OR EQUIPMENT WITHIN THE FACILITIES. I/WE ALSO ASSUME ALL RESPONSIBILITY FOR ABIDING BY THE RECOMMENDATIONS OF SAID MEDICAL PRACTITIONER, INCLUDING BUT NOT LIMITED TO, AS THEY PERTAIN TO LIMITATIONS ON EXERCISE, PARTICIPATING IN YMCA PROGRAMS AND USE OF YMCA FACILITIES OR EQUIPMENT WITHIN YMCA FACILITIES.
Furthermore, in consideration of my/our participation in the activities of the Young Men’s Christian Association of Philadelphia, I/We do hereby agree to hold free from any and all liability the 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 Philadelphia Freedom Valley 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 child care services.
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 noncommercial use of such photographs or motion pictures.
I understand that the Philadelphia Freedom Valley YMCA has no control over and is not responsible for the content in such publication and broadcasts.
I hereby and forever waive payment or royalties for the exhibition or showing of photographs or motion pictures and/or the use of information provided by me.
TERMS AND CONDITIONS:
I agree to abide by the rules and regulation 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 Philadelphia Freedom Valley YMCA. Therefore, we reserve the right to deny access or membership to any person whose behavior is judged to be in conflict with the welfare and safety of other members and/or staff; who is a registered offender; has plead guilty to or been convicted of any crime involving sexual abuse; or a crime against persons such as child, spousal or parental abuse or any offense relating 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.
Members are expected to purchase a membership at the branch they intend to use most of the time. Members may use all branches within the Philadelphia Freedom Valley YMCA Association. We reserve the right to transfer a membership if a member violates this policy. The YMCA will notify the member 30 days in advance of the transfer.
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.