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Complete this waiver
to receive a free three-day pass!

Be Our Guest
Free guest passes to the YMCA are for first-time users who live in Western North Carolina only. Please give us a call if you've visited our facilities before and would like more information on the benefits of being a member.

3 Reasons to Try the YMCA

1. Free consultation with a professional, certified YMCA Wellness Coach will help you create a plan that works for your schedule and ensures success.

2. With free group exercise classes, free family events, free child watch, and a variety of kids' classes, there's something for everyone!

3. No contracts, and financial assistance is available to those in need.

First Guest's Name

First Name*

Middle Name

Last Name*

Phone*
First Guest's Date of Birth*
First Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
First Guest's Signature*
Second Guest's Name

First Name*

Middle Name

Last Name*
Second Guest's Date of Birth*
Second Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Second Guest's Signature*
Third Guest's Name

First Name*

Middle Name

Last Name*
Third Guest's Date of Birth*
Third Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Third Guest's Signature*
Fourth Guest's Name

First Name*

Middle Name

Last Name*
Fourth Guest's Date of Birth*
Fourth Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Fourth Guest's Signature*
Fifth Guest's Name

First Name*

Middle Name

Last Name*
Fifth Guest's Date of Birth*
Fifth Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Fifth Guest's Signature*
Sixth Guest's Name

First Name*

Middle Name

Last Name*
Sixth Guest's Date of Birth*
Sixth Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Sixth Guest's Signature*
Seventh Guest's Name

First Name*

Middle Name

Last Name*
Seventh Guest's Date of Birth*
Seventh Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Seventh Guest's Signature*
Eighth Guest's Name

First Name*

Middle Name

Last Name*
Eighth Guest's Date of Birth*
Eighth Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Eighth Guest's Signature*
Ninth Guest's Name

First Name*

Middle Name

Last Name*
Ninth Guest's Date of Birth*
Ninth Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Ninth Guest's Signature*
Tenth Guest's Name

First Name*

Middle Name

Last Name*
Tenth Guest's Date of Birth*
Tenth Guest's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Tenth Guest's Signature*
Guest's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent's or Guardian's Email Address

Email*
Yes, I'd like to receive YMCA news and information.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
I am...
YMCA of WNC Liability Waiver

MEMBERSHIP WAIVER/ASSUMPTION OF THE RISKS

I, on behalf of myself, members of my household or minor children, and any heirs and assigns, guardians, executors, administrators, and legal representatives of me, members of my household or minor children ("Releasing Parties"), waive and release any and all rights and claims for damages, demands, and any other actions whatsoever, including those attributable to simple negligence, that any of the Releasing Parties may have against the YMCA of Western North Carolina and its agents, employees, contractors, volunteers, representatives, successors, and assigns ("YMCA"), for any and all injuries or damage, which may arise out of or in connection with Releasing Parties' use of any YMCA facilities or participation in any YMCA activities and programs. I agree to indemnify and hold harmless the YMCA and understand that the YMCA assumes no responsibility or liability for any injuries, illness, or damage that Releasing Parties may sustain as a result of any physical condition of Releasing Parties, or resulting from Releasing Parties' observation or participation in any YMCA activity, or use of any YMCA facilities, or equipment. I expressly acknowledge on behalf of Releasing Parties that Releasing Parties assume the risk for any and all injuries, illness, and damage that may result from Releasing Parties participation in these activities. I/RELEASING PARTIES FURTHER VERIFY THAT I/RELEASING PARTIES HAVE FULL KNOWLEDGE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THE YMCA ACTIVITIES AND PROGRAMS. I/RELEASING PARTIES EXPRESSLY, KNOWINGLY, AND VOLUNTARILY ASSUME THE RISKS INVOLVED IN THE ACTIVITIES AND PROGRAMS AND AGREE TO HOLD THE YMCA HARMLESS FOR ANY RESULTING INJURY.  I understand that this waiver and assumption of the risk shall remain in effect until notice of cancellation is received by the YMCA.  I further understand that should I decline to execute this agreement, I will not be permitted to attend or participate in the activities and programs.

If my membership is eligible to participate in the YMCA Nationwide Membership Program, I understand that by participating in the YMCA Nationwide Membership Program, I/Releasing Parties 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. 

OTHER CONDITIONS OF MEMBERSHIP/PROGRAM PARTICIPATION

The YMCA has the right to suspend and/or terminate any membership or program participation for violation of any posted or written rules of conduct, for any behavior that interferes with the enjoyment of the YMCA by others, and for any inappropriate behavior at the YMCA, including but not limited to sexual conduct, abusive or threatening language, theft, fighting, or assault. YMCA memberships are nontransferable. The YMCA conducts regular sex offender screenings on all members, participants, and guests. If a match occurs on the registry, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access. The YMCA has the right to suspend and/or terminate any membership/program participation at any time. Members must present their membership card or verify their identity for entry into any facility. The management of the YMCA has the right to suspend and/or terminate any membership for nonpayment of fees. 

PHOTO/AUDIO VISUAL/NARRATIVE RELEASE

For my participation in activities to be conducted by the National Council of Young Men's Christian Associations of the United States of America ("YMCA of the USA") or any of its chartered member associations in the United States (collectively "the Y"), and collaborating third parties, I consent, now and for all time, to the making, reproduction, editing, broadcasting or rebroadcasting of video film or footage of me, sound track recordings of me, photo reproductions of me, and any narrative account of my experience. My consent includes a perpetual license to the Y and collaborating third-parties for the use of the above materials for publication, display, sale or exhibition in promotions, advertising, education and commercial uses. Use includes reproductions in any form and media currently existing or later conceived, adaptations and/or revisions, throughout the world in perpetuity. 

I understand and agree there may be no additional compensation for this license, and I will not make any claim for payment of any kind from the Y or collaborating third-parties. I may, or may not be, identified in such licensed uses; however, my name will not be used to endorse any particular products or services. With respect to any of the above uses, I further agree that all works shall belong to YMCA of the USA; the Y has no duty of confidentiality regarding any licensed uses; YMCA of the USA shall exclusively own all known or later existing rights to the uses throughout the world; photo reproductions of me and/or my narrative account for any purpose without additional compensation to me. I agree that my consent is irrevocable. I hereby release and discharge The Y and collaborating third-parties, from any and all claims, actions, lawsuits or demands of any kind arising out of my consent, license grants, uses, or the shared uses of any works or materials referenced herein.

PROGRAM PARTICIPATION WAIVER/ASSUMPTION OF THE RISKS

I, on behalf of myself and minor children, and any heirs and assigns, guardians, executors, administrators, and legal representatives of me, members of my household or minor children ("Releasing Parties"), waive and release any and all rights and claims for damages, demands, and any other actions whatsoever, including those attributable to simple negligence, that any of the Releasing Parties may have against the YMCA of Western North Carolina and its agents, employees, contractors, volunteers, representatives, successors, and assigns ("YMCA"), for any and all injuries or damage, which may arise out of or in connection with Releasing Parties' use of any YMCA facilities or participation in any YMCA activities and programs. I agree to indemnify and hold harmless the YMCA and understand that the YMCA assumes no responsibility or liability for any injuries, illness, or damage that Releasing Parties may sustain as a result of any physical condition of Releasing Parties, or resulting from Releasing Parties' observation or participation in any YMCA activity, or use of any YMCA facilities, or equipment. I/RELEASING PARTIES FURTHER VERIFY THAT I/RELEASING PARTIES HAVE FULL KNOWLEDGE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THE YMCA ACTIVITIES AND PROGRAMS. I/RELEASING PARTIES EXPRESSLY, KNOWINGLY, AND VOLUNTARILY ASSUME THE RISKS INVOLVED IN THE ACTIVITIES AND PROGRAMS AND AGREE TO HOLD THE YMCA HARMLESS FOR ANY RESULTING INJURY.  I understand that this waiver and assumption of the risk shall remain in effect until notice of cancellation is received by the YMCA.  I further understand that should I decline to execute this agreement, I/Releasing Parties will not be permitted to attend or participate in the activities and programs.

OTHER CONDITIONS OF MEMBERSHIP/PROGRAM PARTICIPATION

The YMCA has the right to suspend and/or terminate any membership or program participation for violation of any posted or written rules of conduct, for any behavior that interferes with the enjoyment of the YMCA by others, and for any inappropriate behavior at the YMCA, including but not limited to sexual conduct, abusive or threatening language, theft, fighting, or assault. YMCA memberships are nontransferable. The YMCA conducts regular sex offender screenings on all members, participants, and guests. If a match occurs on the registry, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access. The YMCA has the right to suspend and/or terminate any membership/program participation at any time. Members must present their membership card or verify their identity for entry into any facility. The management of the YMCA has the right to suspend and/or terminate any membership for nonpayment of fees. 

MEMBERSHIP WAIVER/ASSUMPTION OF THE RISKS

I, on behalf of myself, members of my household or minor children, and any heirs and assigns, guardians, executors, administrators, and legal representatives of me, members of my household or minor children ("Releasing Parties"), waive and release any and all rights and claims for damages, demands, and any other actions whatsoever, including those attributable to simple negligence, that any of the Releasing Parties may have against the YMCA of Western North Carolina and its agents, employees, contractors, volunteers, representatives, successors, and assigns ("YMCA"), for any and all injuries or damage, which may arise out of or in connection with Releasing Parties' use of any YMCA facilities or participation in any YMCA activities and programs. I agree to indemnify and hold harmless the YMCA and understand that the YMCA assumes no responsibility or liability for any injuries, illness, or damage that Releasing Parties may sustain as a result of any physical condition of Releasing Parties, or resulting from Releasing Parties' observation or participation in any YMCA activity, or use of any YMCA facilities, or equipment. I expressly acknowledge on behalf of Releasing Parties that Releasing Parties assume the risk for any and all injuries, illness, and damage that may result from Releasing Parties participation in these activities. I/RELEASING PARTIES FURTHER VERIFY THAT I/RELEASING PARTIES HAVE FULL KNOWLEDGE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THE YMCA ACTIVITIES AND PROGRAMS. I/RELEASING PARTIES EXPRESSLY, KNOWINGLY, AND VOLUNTARILY ASSUME THE RISKS INVOLVED IN THE ACTIVITIES AND PROGRAMS AND AGREE TO HOLD THE YMCA HARMLESS FOR ANY RESULTING INJURY.  I understand that this waiver and assumption of the risk shall remain in effect until notice of cancellation is received by the YMCA.  I further understand that should I decline to execute this agreement, I will not be permitted to attend or participate in the activities and programs.

If my membership is eligible to participate in the YMCA Nationwide Membership Program, I understand that by participating in the YMCA Nationwide Membership Program, I/Releasing Parties 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. 

OTHER CONDITIONS OF MEMBERSHIP/PROGRAM PARTICIPATION

The YMCA has the right to suspend and/or terminate any membership or program participation for violation of any posted or written rules of conduct, for any behavior that interferes with the enjoyment of the YMCA by others, and for any inappropriate behavior at the YMCA, including but not limited to sexual conduct, abusive or threatening language, theft, fighting, or assault. YMCA memberships are nontransferable. The YMCA conducts regular sex offender screenings on all members, participants, and guests. If a match occurs on the registry, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access. The YMCA has the right to suspend and/or terminate any membership/program participation at any time. Members must present their membership card or verify their identity for entry into any facility. The management of the YMCA has the right to suspend and/or terminate any membership for nonpayment of fees. 

PHOTO/AUDIO VISUAL/NARRATIVE RELEASE

For my participation in activities to be conducted by the National Council of Young Men's Christian Associations of the United States of America ("YMCA of the USA") or any of its chartered member associations in the United States (collectively "the Y"), and collaborating third parties, I consent, now and for all time, to the making, reproduction, editing, broadcasting or rebroadcasting of video film or footage of me, sound track recordings of me, photo reproductions of me, and any narrative account of my experience. My consent includes a perpetual license to the Y and collaborating third-parties for the use of the above materials for publication, display, sale or exhibition in promotions, advertising, education and commercial uses. Use includes reproductions in any form and media currently existing or later conceived, adaptations and/or revisions, throughout the world in perpetuity. 

I understand and agree there may be no additional compensation for this license, and I will not make any claim for payment of any kind from the Y or collaborating third-parties. I may, or may not be, identified in such licensed uses; however, my name will not be used to endorse any particular products or services. With respect to any of the above uses, I further agree that all works shall belong to YMCA of the USA; the Y has no duty of confidentiality regarding any licensed uses; YMCA of the USA shall exclusively own all known or later existing rights to the uses throughout the world; photo reproductions of me and/or my narrative account for any purpose without additional compensation to me. I agree that my consent is irrevocable. I hereby release and discharge The Y and collaborating third-parties, from any and all claims, actions, lawsuits or demands of any kind arising out of my consent, license grants, uses, or the shared uses of any works or materials referenced herein.

PROGRAM PARTICIPATION WAIVER/ASSUMPTION OF THE RISKS

I, on behalf of myself and minor children, and any heirs and assigns, guardians, executors, administrators, and legal representatives of me, members of my household or minor children ("Releasing Parties"), waive and release any and all rights and claims for damages, demands, and any other actions whatsoever, including those attributable to simple negligence, that any of the Releasing Parties may have against the YMCA of Western North Carolina and its agents, employees, contractors, volunteers, representatives, successors, and assigns ("YMCA"), for any and all injuries or damage, which may arise out of or in connection with Releasing Parties' use of any YMCA facilities or participation in any YMCA activities and programs. I agree to indemnify and hold harmless the YMCA and understand that the YMCA assumes no responsibility or liability for any injuries, illness, or damage that Releasing Parties may sustain as a result of any physical condition of Releasing Parties, or resulting from Releasing Parties' observation or participation in any YMCA activity, or use of any YMCA facilities, or equipment. I/RELEASING PARTIES FURTHER VERIFY THAT I/RELEASING PARTIES HAVE FULL KNOWLEDGE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THE YMCA ACTIVITIES AND PROGRAMS. I/RELEASING PARTIES EXPRESSLY, KNOWINGLY, AND VOLUNTARILY ASSUME THE RISKS INVOLVED IN THE ACTIVITIES AND PROGRAMS AND AGREE TO HOLD THE YMCA HARMLESS FOR ANY RESULTING INJURY.  I understand that this waiver and assumption of the risk shall remain in effect until notice of cancellation is received by the YMCA.  I further understand that should I decline to execute this agreement, I/Releasing Parties will not be permitted to attend or participate in the activities and programs.

OTHER CONDITIONS OF MEMBERSHIP/PROGRAM PARTICIPATION

The YMCA has the right to suspend and/or terminate any membership or program participation for violation of any posted or written rules of conduct, for any behavior that interferes with the enjoyment of the YMCA by others, and for any inappropriate behavior at the YMCA, including but not limited to sexual conduct, abusive or threatening language, theft, fighting, or assault. YMCA memberships are nontransferable. The YMCA conducts regular sex offender screenings on all members, participants, and guests. If a match occurs on the registry, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access. The YMCA has the right to suspend and/or terminate any membership/program participation at any time. Members must present their membership card or verify their identity for entry into any facility. The management of the YMCA has the right to suspend and/or terminate any membership for nonpayment of fees. 

PHOTO/AUDIO VISUAL/NARRATIVE RELEASE

For my participation in activities to be conducted by the National Council of Young Men's Christian Associations of the United States of America ("YMCA of the USA") or any of its chartered member associations in the United States (collectively "the Y"), and collaborating third parties, I consent, now and for all time, to the making, reproduction, editing, broadcasting or rebroadcasting of video film or footage of me, sound track recordings of me, photo reproductions of me, and any narrative account of my experience. My consent includes a perpetual license to the Y and collaborating third-parties for the use of the above materials for publication, display, sale or exhibition in promotions, advertising, education and commercial uses. Use includes reproductions in any form and media currently existing or later conceived, adaptations and/or revisions, throughout the world in perpetuity. 

I understand and agree there may be no additional compensation for this license, and I will not make any claim for payment of any kind from the Y or collaborating third-parties. I may, or may not be, identified in such licensed uses; however, my name will not be used to endorse any particular products or services. With respect to any of the above uses, I further agree that all works shall belong to YMCA of the USA; the Y has no duty of confidentiality regarding any licensed uses; YMCA of the USA shall exclusively own all known or later existing rights to the uses throughout the world; photo reproductions of me and/or my narrative account for any purpose without additional compensation to me. I agree that my consent is irrevocable. I hereby release and discharge The Y and collaborating third-parties, from any and all claims, actions, lawsuits or demands of any kind arising out of my consent, license grants, uses, or the shared uses of any works or materials referenced herein.

For my participation in activities to be conducted by the National Council of Young Men's Christian Associations of the United States of America ("YMCA of the USA") or any of its chartered member associations in the United States (collectively "the Y"), and collaborating third parties, I consent, now and for all time, to the making, reproduction, editing, broadcasting or rebroadcasting of video film or footage of me, sound track recordings of me, photo reproductions of me, and any narrative account of my experience. My consent includes a perpetual license to the Y and collaborating third-parties for the use of the above materials for publication, display, sale or exhibition in promotions, advertising, education and commercial uses. Use includes reproductions in any form and media currently existing or later conceived, adaptations and/or revisions, throughout the world in perpetuity. 

I understand and agree there may be no additional compensation for this license, and I will not make any claim for payment of any kind from the Y or collaborating third-parties. I may, or may not be, identified in such licensed uses; however, my name will not be used to endorse any particular products or services. With respect to any of the above uses, I further agree that all works shall belong to YMCA of the USA; the Y has no duty of confidentiality regarding any licensed uses; YMCA of the USA shall exclusively own all known or later existing rights to the uses throughout the world; photo reproductions of me and/or my narrative account for any purpose without additional compensation to me. I agree that my consent is irrevocable. I hereby release and discharge The Y and collaborating third-parties, from any and all claims, actions, lawsuits or demands of any kind arising out of my consent, license grants, uses, or the shared uses of any works or materials referenced herein.

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent's or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent's or Guardian's Date of Birth*
Parent's or Guardian's Information
Are you currently a resident of Western North Carolina?
Ethnic background*

If Other, please list
Gender
Branch I will be visiting*
Parent's or Guardian's Signature*
Electronic Signature Consent*
By checking 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 checking 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.


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