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WELCOME! 

We are excited you have chosen to visit us.  Please read and sign the guest waiver below and then provide your contact information and the additional information requested. When you arrive at the front desk, please show your photo identification to the staff at the front desk. 

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.

Today's date:  September 17, 2021

 

RELEASE OF LIABILITY - GUEST WAIVER FORM

I expressly acknowledge that there are certain dangers, risks, illnesses, personal injuries and death inherent in attending and/or participating in the YMCA's programs, events, classes, and any other activities (including, but not limited to tennis, individual exercise, strength training, group exercise, sports, challenges, competitions, horseback riding, self-defense, archery, field trips, waterfront and pool activities, canoeing/boating, campfires, hiking, high ropes and other challenge courses) at and/or sponsored by the YMCA, which may result from falls, accidents or injuries, negligence of any person or organization, my participation in the programs, events, classes and any other activities, the update of any facilities and equipment, exercise, or from my or my minor child(ren)'s or war(s)' physical condition (collectively, the "Activities"). I understand that the YMCA, and it's employees, agents, counselors, teachers, trainers, representatives, successors and assigns (collectively "Released Parties") assume no responsibility for loss, damage, illness, injury, or death to person or property that I or my minor child(ren) and ward(s), if applicable, may sustain arising out of, resulting from or in any way connected with the Activities, including by reason of the active or passive negligence of any of the Released Parties. I expressly acknowledge, on behalf of myself and my minor child(ren) and ward(s), heirs and executors, that I voluntarily assume the sole risk for any and all losses, damages, illnesses, personal injuries or death that may result from my or my minor child(ren)s’ or ward(s) Activities at and/or sponsored by the YMCA. In consideration of the Released Parties allowing me and/or my minor child(ren) or ward(s) to attend and/or participate in the Activities, I hereby, for myself, my minor child(ren) or ward(s), heirs and executors, waive, release, and forever discharge the Released Parties from and against any and all rights and claims for any loss, damage, illness, injuries or death to person or property sustained arising out of, resulting from or in any way connected with the Activities, whether or not such loss, damage, illness, injury or death results from the negligence of the Released Parties or from some other cause. I also acknowledge that the Released Parties may use photographs, videotapes, television programs, motion pictures, tape recordings, or other similar media pertaining to the Activities for promotional purposes. I hereby consent to the use of my and/or my minor child(ren) or ward(s)’ name(s) and/or likeness(es) in such materials to be exhibited and used for advertising, trade purposes, sociation of patronage, promotional purposes or other similar purposes, even if my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es) are an integral part of such photograph, videotape, television programs, motion picture, tape recording, or other similar media. I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape recording or other use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es), including any written article, script, caption, or other writing that may accompany such use of my and/or my minor child(ren)’s or ward(s)’  name(s) and/or likeness(es). I hereby, for myself for myself, my minor child(ren) or ward(s), heirs and executors, waive, release, and forever discharge the Released Parties from and against any and all liability, claims, losses, costs expenses or damages from libel, slander, invasion of privacy, conversation, defamation, appropriation of likeness or any other claim based on the use of for myself, my minor child(ren) or ward(s) name(s) and/or likeness(es) in any such material. I hereby represent and warrant to the Released Parties that I have the authority to execute this Participant Waiver Form on behalf of myself and/or on behalf of my minor child(ren) or ward(s) as parent, guardian and/or next friend, if applicable, in the event of any misrepresentations or breach of the foregoing warranty by me, or in the event that I, my minor child(ren) or ward(s) or any other person nevertheless asserts any claim against the Released Parties arising out of my minor child(ren)’s or ward(s)’ attendance or participation in the Activities as set forth herein, I agree to indemnify, hold harmless and defend the Released Parties from and against any and all liability, claims, loss, costs, expense or damages arising there from, including, but not limited to, claims of loss, damage, illness, injury or death to person or property whether or not such loss, damage, injury or death results from the negligence of the Released Parties or from some other cause.

I have read the Terms and Conditions agreement.

I Agree

First Guest Name

First Name*

Last Name*

Phone*
First Guest Date of Birth*
First Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
First Guest Signature*
Second Guest Name

First Name*

Last Name*
Second Guest Date of Birth*
Second Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Third Guest Name

First Name*

Last Name*
Third Guest Date of Birth*
Third Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Fourth Guest Name

First Name*

Last Name*
Fourth Guest Date of Birth*
Fourth Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Fifth Guest Name

First Name*

Last Name*
Fifth Guest Date of Birth*
Fifth Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Sixth Guest Name

First Name*

Last Name*
Sixth Guest Date of Birth*
Sixth Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Seventh Guest Name

First Name*

Last Name*
Seventh Guest Date of Birth*
Seventh Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Eighth Guest Name

First Name*

Last Name*
Eighth Guest Date of Birth*
Eighth Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Ninth Guest Name

First Name*

Last Name*
Ninth Guest Date of Birth*
Ninth Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Tenth Guest Name

First Name*

Last Name*
Tenth Guest Date of Birth*
Tenth Guest Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Guest 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 or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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 or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Gender Identification *
The main reason I visited today*

If playing with a group, please include the last name of the reservation
I am interested in (please check all that apply)...
Discussing membership options for YMCA Arlington
Volunteering
Donating to the YMCA
Learning about hosting a birthday party or social event at the YMCA Arlington Tennis & Squash Center
Other

If you have an other interest at the Y, please provide details.
Parent 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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