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YMCA OF SAN DIEGO COUNTY

MINOR WAIVER (GUEST)

FOR NON-YMCA MEMBER USE ONLY

YMCA RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT FOR MINORS

I, the undersigned parent/person having legal custody/guardianship of the above said minor, give permission for the minor to participate in all YMCA programs whether at a YMCA location or virtually from wherever the minor may be. The minor is physically able and mentally prepared to participate in all activities as described in the announcement for the program.

In consideration of said minor being permitted to enter any branch of the YMCA of San Diego County ("YMCA") for observation, use of facilities and/or equipment, or participation of the above in any program either in person or virtually, I, on behalf of myself (as parent, guardian, coach, aide, spectator or participant) hereby:

1.  Acknowledge that (i) I have read this document, (ii) I have inspected the YMCA facilities and equipment, (iii) I accept them as being safe and reasonably suited for the purposes intended and (iv) I voluntarily sign this document.

2.  Except for YMCA's gross negligence or willful misconduct I release the YMCA, its directors, officers, employees and volunteers (collectively "Releasees") from all liability to me or the above said minor, for any loss or damage to property or injury or death to person, whether said damage or injury results from conditions arising upon the YMCA facilities or arising out of or in connection with YMCA programs or activities. YMCA shall not be liable for any damages arising from any act or neglect of any other member, occupant or user of the YMCA premises or participant in YMCA programs or activities. I agree that the above said minor assumes full responsibility for, and risk of, bodily injury, death or property damage except caused or due to the gross negligence or willful misconduct of the YMCA.

3.  I agree not to sue Releasees for any loss, damage, injury or death described above and except for YMCA's gross negligence or willful misconduct, I will indemnify, protect, defend and hold harmless the YMCA and its Releasees from and against any and all claims and/or damages, liens, judgments, penalties, attorneys' and consultants' fees, expenses and/or liabilities arising out of, involving, or in connection with, the YMCA membership, use of YMCA facilities and/or participation in YMCA programs by me, the above said minor or any other person. If any action or proceeding is brought against YMCA by reason of any of the foregoing matters, I shall upon notice defend the same at my expense by counsel reasonably satisfactory to YMCA and YMCA shall cooperate with me in such defense. YMCA need not have first paid any such claim in order to be defended or indemnified.

4.  I do hereby authorize the YMCA as agent for the undersigned, to consent with respect to said minor, to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under general or special supervision of, any physician and surgeon licensed under the provisions of the California Medical Practice Act on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. I understand that the YMCA is not responsible for costs incurred for medical care.

 

 

COVID-19 ASSUMPTION OF RISK AND RELEASE AND WAIVER

5.  The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of any groups of people other than in your own household. YMCA of San Diego County (“YMCA”) has put in place preventative measures suggested by the Centers for Disease Control and Federal, State, and Local Government to reduce the spread of COVID-19; however, YMCA cannot guarantee that you or your child will not become infected with COVID-19. Further, attending YMCA facilities, programs or childcare could increase your family’s risk, your risk, and your child’s risk of contracting COVID-19. By signing this agreement, I acknowledge the highly contagious nature of COVID-19 and voluntarily assume the risk that my child and I along with my family may be exposed to or infected by COVID-19 by attending YMCA facilities, programs or childcare and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at YMCA facilities, programs or childcare may result from the actions, omissions, or negligence of myself and others, including, but not limited to, YMCA employees, volunteers, and program participants and their families I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child or my family may experience or incur in connection with my child’s attendance at YMCA or participation in YMCA programming (“Claims”). On my behalf, and on behalf of my family and children, I hereby release, covenant not to sue, discharge, and hold harmless YMCA, its employees, agents, and representatives, of and from any and all Claims, including all liabilities, claims, actions, suits, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of YMCA, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any YMCA program.

I intend this document to be as broad and inclusive as is permitted by the laws of the State of California; if any portion hereof is held invalid, I agree the balance shall continue in full force and effect.

 

 

   Parent/Legal Guardian

 

CONCUSSION ACKNOWLEDGEMENT 

I acknowledge receipt of the concussion and head injury information, and I agree to discuss the risks of concussion and head injury with my child/children.

Concussion and Head Injury Information: https://www.ymcasd.org/docs/concussion

I Agree

 

YMCA OF SAN DIEGO COUNTY CODE OF CONDUCT

The YMCA of San Diego County is dedicated to providing a safe and welcoming environment for all its members and guests. The YMCA is an organization open to all people. We welcome and value individuals of all ages, races, ethnicities, religions, gender identities, abilities, sexual orientations and financial circumstances. We are committed to having programs and services that embrace diversity, reflecting the people and needs of our communities.

To promote safety, all individuals are asked to act appropriately and follow the rules/guidelines at all times within our facility or when participating in our programs. This includes following any revised guidelines and protocols related to the pandemic situation, or as otherwise instructed by the CDC and local government. The YMCA of San Diego is an anti-racist, diverse, and inclusive service organization, which prohibits hate, racism, and discrimination within our YMCA and the communities we serve. We expect persons using the Y to act maturely, to behave responsibly, and to respect the rights and dignity of others. The following actions listed below are behaviors considered inappropriate in our facilities, programs and in online communities, and therefore not allowed. Please note this is not an exhaustive list.

  • Illegal chemicals or alcohol. Using, possessing or under the influence of alcohol or drugs on YMCA property or at Y sponsored programs.
  • Smoking. The use of tobacco or tobacco-like products, including e-cigarettes or vaping. The YMCA is a drug free environment.
  • Weapons. Carrying or concealing any weapons or devices or objects that may be used as, or look like weapons. Exception is those carried by qualified active and/or retired law enforcement.
  • Harassment / intimidation. Harassment or intimidation by words, gestures, body language or any menacing behavior that demeans another person or culture.
  • Threatening physical contact. Physical contact with another person in any hostile or threatening way including but not limited to “play fighting.”
  • Inappropriate language. Hostile or vulgar language, including swearing, name-calling or shouting.
  • Inappropriate conduct. Any other conduct of an inappropriate, threatening or offensive nature.
  • Inappropriate attire. Clothing with vulgar language, obscene gestures, racial slurs, or anything that contributes to a hostile environment or would be considered inappropriate in a family facility.
  • Sexual activity. Any demonstration of sexual activity, sexual contact with another person or sexually explicit conversation and behavior.
  • Theft / destruction of property. Theft or behavior that results in the destruction of property.
  • Loitering. Loitering in or outside YMCA facilities or programs and/or inappropriate use of Y facilities.
  • Inappropriate cell phone activity. Cell phone or photographic/video equipment use of any kind – organizing playlists, music, texting, camera functions, video recording – is not permitted in the locker rooms at any time (including unauthorized photography of facilities, members orparticipants). Phone calls are not allowed in fitness areas.
  • Social Media. Use of social networking in a manner that is contrary to the Y’s mission, is detrimental to the community or is in violation of the law.

The YMCA of San Diego County reserves the right to deny access or membership to any person who has been convicted of any crime related to abuse in a sexual manner. Members and guests are encouraged to take responsibility for their actions, comfort and safety. Anyone who witnesses behavior that goes against our Code of Conduct is encouraged to report the behavior to a staff person or Manager on Duty immediately (versus confronting another member directly). Suspension or termination of YMCA membership privileges may result if the YMCA determines that a violation of this Code of Conduct has occurred, and/or if multiple warnings have been provided previously.

I Agree

First Participant's Name

First Name*

Middle Name

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Activity
What activity will you be participating in?*
Photo Waiver/Consent
I give my permission to the YMCA of San Diego County (YMCA) to use one or more pictures or other likeness of my child in the YMCA's general publicity, media and campaign materials. *
I Agree
I Do Not Agree
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*

Middle Name

Last Name*
Parent or Guardian's Date of Birth*
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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