YMCA Silver Spring New Membership Application

YMCA Silver Spring Membership Application

The mission of the YMCA of Metropolitan Washington is to foster the spiritual, mental and physical development of individuals, families and communities according to the ideals of inclusiveness, equality and mutual respect for all. Thank you for choosing to join the YMCA!
Is the primary member 18 years of age or older?*
Parent/Guardian Authorization (for Minor Memberships):
I, the undersigned, certify that I am the parent or legal guardian of the minor listed on this application. I affirm that all information provided is accurate to the best of my knowledge. I hereby grant permission for my child to participate in YMCA programs and activities in accordance with the policies of the YMCA. I accept full responsibility for any obligations, including financial, that may arise from their membership and participation. I understand and agree to abide by all YMCA policies on behalf of my child.
Name of Parent / Guardian completing this form*

First NameLast Name
Date of Birth for Parent / Guardian completing this form*

MonthDayYear
Date
Signature of Parent / Guardian completing this form *

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PRIMARY MEMBERSHIP APPLICANT

Enter the information for the primary member / individual on the membership. If the primary member is under the age of 18, this page must be completed by their parent / guardian.
Primary Member Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender Identification
Phone Number*
Format: (000) 000-0000.
Email Address*
example@example.com
Confirm Email Address*
example@example.com
PhoneEmailText
I Agree

ADDITIONAL ADULT or SENIOR MEMBERSHIP DETAILS

Please complete for the additional ADULT or SENIOR in the membership household.
Name*

First NameLast Name
Gender Identification
*
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com

FAMILY MEMBERSHIP DETAILS

Please complete for the CHILD / CHILDREN in the same family membership household.
No childrenOne childTwo childrenThree childrenFour childrenFive children
First Child's Name*

First NameLast Name
Gender Identification
blanks*
Date of Birth*

MonthDayYear
Date
Second Child's Name*

First NameLast Name
Gender Identification
blanks*
Date of Birth*

MonthDayYear
Date
Third Child's Name*

First NameLast Name
Gender Identification
blanks*
Date of Birth*

MonthDayYear
Date
Fourth Child's Name*

First NameLast Name
Gender Identification
blanks*
Date of Birth*

MonthDayYear
Date
Fifth Child's Name*

First NameLast Name
Gender Identification
blanks*
Date of Birth*

MonthDayYear
Date

EMERGENCY CONTACT INFORMATION
Name of Emergency Contact (cannot be an individual on your Y membership)*
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Employer (If not applicable, enter N/A)*
Occupation (If not applicable, enter N/A)*

MISSION OF THE YMCA
I agree
LIABILITY WAIVER
My signature acknowledges that I understand the YMCA of Metropolitan Washington assumes no responsibility for injuries or illnesses which I, my spouse/partner, or my minor children or any other person may sustain as a result of my/their physical condition, this membership, my/their use of a facility or my/their participation in any activities, programs, exercise, or the use of any equipment (collectively, “Activities”). I expressly acknowledge on behalf of myself, my spouse/partner, my minor children and our heirs that I assume the risk for any and all injuries, illnesses, death, loss or damage which may result from any of the foregoing. I hereby release and discharge the YMCA of Metropolitan Washington, its agents, servants, and employees from any and all claims for injury, illness, death, loss or damage which I, my spouse/partner, or minor children may suffer as a result of my/their physical condition, this membership, the use of any facility or participation in any Activities. In the event I, my spouse/partner or minor children bring any guest to the YMCA of Metropolitan Washington facility or Activity, I also agree to be responsible for ensuring that such guests adhere to the rules and policies of the YMCA and to inform them that they assume all liability for injuries, illness, death, loss or damage which may result from participation in any activities, programs, exercise or the use of any equipment. By participating in the YMCA Nationwide Membership Program, I agree to release the National Council of Young Men’s Christian Associations 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. Additionally, I understand that the YMCA of Metropolitan Washington is not responsible for personal property lost or stolen while members and/or program participants are using YMCA facilities or are on YMCA premises.*

I agree
CONDITIONS OF MEMBERSHIP
My signature acknowledges that I understand I am responsible for reading and complying with YMCA policies and notices presented to me, including:
- The YMCA of Metropolitan Washington's Membership Handbook, which is available on the YMCA of Metropolitan Washington website. (https://www.ymcadc.org/membership-handbook). I agree to observe the YMCA's policies and procedures as outlined in the Membership Handbook and as they may be amended from time to time. I reserve the right to request and receive an explanation for any provision of the Membership Handbook that I do not understand.
- Policies posted on YMCA property and the YMCA website (i.e. Wellness Floor Policies, Locker Room policies, etc.).
- Notices that are provided to me by YMCA staff or sent to my attention from the YMCA to me via email or direct mail.
YES

ACCOUNT MANAGEMENT
To update membership payment methods; to change your monthly billing date; to change your membership category; or to add or discontinue a recurring monthly gift, please complete a Membership Adjustment Form online at https://ymcadc.org/myaccount/. The Membership Adjustment Form must be completed and submitted one-month in advance of your monthly draft or billing date in order for the applicable change to take effect.

Membership Cancellation Process & Policy: Members that wish to cancel their membership must complete a Membership Cancellation Form online one-month in advance of their monthly draft or billing date in order to avoid paying for the next month’s membership dues. The membership cancellation form is available online at https://ymcadc.org/myaccount/.
- For membership payments on the 26th, membership cancellation forms must be completed by the 26th of the prior month to avoid paying for the next month.
- For membership payments on the 10th, membership cancellation forms must be completed by the 10th of the prior month to avoid paying for the next month.
Membership Leave of Absence Process & Policy: to place a membership on hold, a Leave of Absence Request Form must be submitted by members at least two weeks prior to their next draft of billing date. The Leave of Absence Request Form is available online at (available at https://ymcadc.org/myaccount/). Members may place their membership on hold through the following leave of absence policies:
- Standard Leave of Absence: Members may place their membership on hold for a minimum of 3-months and a maximum of 6-months once per calendar year and pay a monthly inactive fee of $10/month for a one-adult membership or $15/month for a two-adult membership. During a Standard Leave of Absence, in the event that a YMCA branch closes for a full month in compliance with a government mandate or health official requirement, members have the option of donating their membership inactive fees to the YMCA or receiving a credit that can be applied towards a future membership dues payment for each full month that the Y was closed. No credits will be issued for partial month closure.
- Medical Leave of Absence: Members may have their membership temporarily inactivated for a minimum of one-month without fees due to an illness or physical injury (i.e. a member is physically unable to use any of the facilities). For annual members, a credit will be provided for the inactive time. To initiate Medical Leave, please complete the Leave of Absence Request Form online and include the member’s full name, membership ID number, contact information (mailing address, phone number and email address), the name of the home YMCA branch joined, and then send a letter from the member’s physician stating that they must refrain from all exercise for a specific time period to member.service@ymcadc.org. To resume membership access and end the Medical Leave, the member must first present a medical clearance letter from their physician to the YMCA (either via email to member.service@ymcadc.org or to a Y staff member at the branch member service desk).
- Military Leave of Absence: if you are a member of the armed forces, a member of the National Guard serving on full-time duty or a Civil Service technician with a National Guard; and you receive permanent change of station orders to depart the Metropolitan Washington region or receive temporary duty orders in excess of three months’ duration to depart the Metropolitan Washington region, you may inactivate your membership without fee as long as you provide military documentation. When returning from duty, the membership will be reactivated. Members that receive permanent change of station orders to depart the Metropolitan Washington region may cancel their membership and any classes without penalty as long as they provide a copy of their military orders. To initiate Military Leave, please complete the Leave of Absence Request Form online and send the supporting military documentation to member.service@ymcadc.org.
Once membership is placed on hold, members are not permitted to use YMCA facilities (this includes with a guest pass). If member access records reflect your use of YMCA facilities while your membership is on hold, your membership will be reactivated and your account charged. Membership payments automatically resume once the hold period has ended. To reactivate membership ahead of the end of the hold period, please notify the YMCA via email at member.service@ymcadc.org. The YMCA reserves the right to change all of the membership leave of absence policies. In the event that a change to the policies results in increased payments from members, YMCA policy is to notify members by mail 30-days in advance of any increase taking effect.
YES
ACCEPTANCE
I understand and agree to the MEMBERSHIP REFUND POLICY, the ACCOUNT MANAGEMENT details, the MEMBERSHIP CANCELLATION PROCESS & POLICY, and the MEMERSHIP LEAVE OF ABSENCE PROCESS & POLICY
By signing below, I agree to the above statements. *

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GENERAL REQUIREMENTS OF MEMBERSHIP
My signature acknowledges that I understand and agree to the following general requirements of YMCA membership:
- All members are required to present a valid membership card for identification when using YMCA facilities and/or participating in programs. If for any reason members are unable to present membership cards, they are required to present photo identification.
- Membership cards are not transferable; remain the property of the YMCA; and must be returned to the YMCA upon request.
- 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 immediately terminate membership, end program participation, and remove visitation access.
- Membership Category: members are automatically transferred into a new membership category on their birthday, if eligible, in which event dues may increase or decrease. In the event of any other qualifying event that changes the category of membership for which a member is eligible, members agree to notify the YMCA on or before the first day of the month following the month in which such event occurs by completing a Membership Adjustment Form online at www.ymcadc.org/myaccount.
- Monthly Payment Authorization: members that join the Y with a month-to-month membership understand that membership to the YMCA is continuous and agree to the following terms listed for the method of payment that they have selected to use through this application for membership to the YMCA of Metropolitan Washington.
  - BANK DRAFT: members that have elected to pay via BANK DRAFT authorize their bank to honor pre-authorized drafts drawn by the YMCA on their account for membership payments and/or contributions.
  - When the bank honors the draft by charging the member's account, such drafts constitute receipt for the payment. Should any draft not be honored by said bank when received by them, it is understood that the payment is to be made by the member in the amount of said payment, plus a service charge.
  - A voided check is required with all electronic funds transfer applications.
  - CREDIT CARD: members that elect to pay with a CREDIT CARD, to ensure uninterrupted service, authorize the YMCA to charge their credit card for membership payments and/or contributions.
- For either method of monthly payment selected, it is understood that
  - the member's monthly membership will be continuous until the member completes a Membership Cancellation Form one-month in advance of their monthly draft or billing date in order to avoid paying for the next month’s membership dues.
  - any recurring gift the member has elected to make as they have indicated on this Membership Application Form will be continuous until the member completes a Membership Adjustment Form one-month in advance of their monthly draft or billing date in order to be effective for the following month.
  - If at any time, there is to be a change or update to the membership payment methods, a change to the monthly billing date, or a change to the member’s membership category; members must complete a Membership Adjustment Form and submit it one-month in advance of their monthly draft or billing date in order for the applicable change to take effect.
  - The Membership Cancellation Form and Membership Adjustment Form cited above is available at https://ymcadc.org/myaccount/.
- FINANCIAL ASSISTANCE: members that have applied for Financial Assistance agree to the terms of monthly payment plan and understand that they need to re-apply annually for financial assistance.
- MEMBERSHIP FEE STRUCTURE & RATE ADJUSTMENT POLICY: The membership fee structure is reviewed regularly. Increases that occur reflect increases in operating costs and are made to ensure quality programs and services. An annual maintenance fee may be applied to memberships in order to maintain continuity in service delivery to all members. Membership dues, enrollment fees and program fees are subject to change at any time. YMCA policy is to notify members by e-mail at least 30-days in advance of any maintenance fee application or membership dues increase taking effect. This notice will include the specific amount of the maintenance fee or membership dues increase and the date when it begins
YES

MARKETING RELEASE
I understand that the YMCA of Metropolitan Washington may take pictures or record videos of members and non-members participating in YMCA programs, using YMCA facilities, or attending YMCA special events. Additionally, I understand that the YMCA may permit members of the media to take such pictures or record such videos in order to promote the YMCA‘s charitable mission and for other journalistic purposes. Signing this membership application (if the person named below is under age 18, a parent or guardian of such person must sign on such person’s behalf) releases the YMCA and the media to use such photographs, video recordings, and/or sound recordings of me for any purpose consistent with the YMCA’s charitable mission. I understand and agree to the related Marketing policy outlined in the YMCA of Metropolitan Washington Membership Handbook, which states that I am waiving any and all rights that may preclude the YMCA’s or the media’s use of the pictures or recordings as described above, that I acknowledge that neither the YMCA nor the media has any obligation to use any recordings of me, and that I will receive no monetary payment or other compensation in exchange for the rights to use pictures or recordings of me.
YES
I acknowledge the MISSION, LIABILITY WAIVER, CONDITIONS OF MEMBERSHIP, GENERAL REQUIREMENTS OF MEMBERSHIP and MARKETING RELEASE set forth above and in the Membership Handbook, and, being in agreement with the Mission and Goals of the YMCA of Metropolitan Washington, hereby apply for membership.
By signing below, I agree to the above statements. *

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MEMBERSHIP REFUND POLICY
- Refunds and/or credits will not be issued for non-usage of membership or infrequent facility access.
- In the event that a YMCA branch closes for a full month in compliance with a government mandate or health official requirement, members have the option of donating their membership dues to the YMCA or receiving a credit for a future month of membership dues for each full month that the Y was closed. No credits will be issued for partial month closure.
- The enrollment fee is a one-time, non-refundable fee for initiating any new membership (month-to-month or annual). If you cancel your membership and choose to later rejoin the YMCA of Metropolitan Washington, or if your annual membership has expired for longer than 30-days, you will be required to pay the current enrollment fee, which is subject to change.
- Members that join the YMCA through an offer that waives the requirement to pay the enrollment fee are limited to one enrollment fee waiver during any 12-month period.
- When transferring to another YMCA of Metropolitan Washington branch, your enrollment fee will be waived provided your membership is in good standing and that you have transferred to the same or equivalent category of membership.
- Building Maintenance & Branch Revitalization: Every year, YMCA branches may close (from a few days up to two weeks) in August or September for required maintenance, deep cleaning and capital improvements. There are no credits or refunds available during this time, as all members will have access to any YMCA of Metropolitan Washington branch location that is open during this time.
YES

FRIENDS OF THE YMCA
If you are friends with a current member that encouraged you to join the YMCA, please enter their full first name and last name here. We'd like to express our thanks to them for referring you to the YMCA and joining the YMCA family.
ELECTRONIC SIGNATURE CONSENT

By signing here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By signing here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.
Signature

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YMCA Silver Spring Membership Application

PRIMARY MEMBERSHIP APPLICANT

MEMBERSHIP APPLICATION DETAILS

ADDITIONAL ADULT or SENIOR MEMBERSHIP DETAILS

FAMILY MEMBERSHIP DETAILS

EMERGENCY CONTACT INFORMATION

MEMBERSHIP PAYMENT

COMMUNITY SUPPORT

MEMBERSHIP GOALS, INTERESTS, & ONBOARDING EXPERIENCES

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

MISSION OF THE YMCA

LIABILITY WAIVER

CONDITIONS OF MEMBERSHIP

ACCOUNT MANAGEMENT

ACCEPTANCE

GENERAL REQUIREMENTS OF MEMBERSHIP

MARKETING RELEASE

MEMBERSHIP REFUND POLICY

FRIENDS OF THE YMCA

ELECTRONIC SIGNATURE CONSENT