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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...
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*
YMCA of WNC Liability Waiver*
I hereby, for myself, my household, my family, heirs, executors and administrators, waive and release any and all claims and damages I may have against the YMCA of Western North Carolina and Y-USA (YMCA) and their respective agents, representatives, successors, and assigns, for any and all injuries which may be suffered by me, my household, or my family in connection with participation in YMCA activities and programs.<br><br> I understand that the YMCA assumes no responsibility for injuries or illnesses which, I, my household or family may sustain as a result of our physical condition, or resulting from our observation or participation in any activity or use of facilities or equipment used for YMCA activities. I expressly acknowledge on behalf of myself and my heirs that I assume the risk for any and all injuries and illnesses for myself, my household or family, which may result from participation in these activities.<br><br> Any individual who has been convicted of a sexual offense shall be denied membership, program, or volunteer participation at the YMCA of Western North Carolina. The YMCA also has the right to suspend and/or terminate any membership for violation of any posted or written rules of conduct, for any behavior that interferes with the enjoyment of the YMCA, and for any inappropriate behavior at the YMCA, including but not limited to inappropriate sexual conduct, abusive or threatening language, fighting, or assault.<br><br> The management of the YMCA has the right to suspend and/or terminate any membership for non payment of dues or fees.<br><br> I grant full permission to the YMCA to use any photographs, audio or video recordings taken of me, my household, or my family at YMCA locations and/or events. I agree for the YMCA to send communication to me via text message if I am 13 years or older and emails with program information.<br><br> I agree on behalf of myself, my household, my family with the YMCA policies and procedures and understand that my/our household membership can be revoked without refund for exhibiting inappropriate behavior or abuse toward the YMCA staff and/or facilities.


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