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WELCOME! 

Thank you for visiting the YMCA. Please sign the non-member participant waiver and complete the information requested below. Check-in at the front desk is required prior to accessing the courts. Please share your photo identification with the Y staff at the front desk to check-in. 

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:  December 1, 2023

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 pickleball, 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 weather and related condition of the courts/property; the state of any facilities and equipment; or from my or my minor child(ren)'s or ward(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 Agree

 

COVID-19

Coronavirus, COVID-19, is an extremely contagious virus that spreads easily through person-to-person contact. An inherent risk of exposure to COVID-19 exists in any public place where people are present. Federal and state authorities recommend social distancing as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, reproductive harm, permanent disability, and death. According to the Centers for Disease Control and Prevention, senior citizens and persons with underlying medical conditions are especially vulnerable. I acknowledge that by participating in or observing YMCA programs, events, classes, and other activities, or even merely accessing YMCA facilities; I may increase the risk of contracting COVID-19 or other infectious diseases. The YMCA in no way warrants that COVID-19 infection or other infectious diseases will not occur through participation in or observation of YMCA programs, events, classes, and other activities or accessing YMCA facilities. By participating in or observation of YMCA programs, events, classes and other activities, or accessing YMCA facilities, I voluntarily assume all risks associated with exposure to COVID-19. The YMCA will not be liable for any claims associated with, any illness, personal injury, disability or death associated with COVID-19, even if it can be established that I or my child(ren) or dependent(s) contracted an infection through participation in YMCA programs, events, classes, and other activities or accessing YMCA facilities. Anyone exhibiting symptoms of COVID-19 or who was recently exposed to COVID-19 within the preceding 14-day period must refrain from participating or observing, in any YMCA programs, events, classes, and other activities, or access YMCA facilities.

I have been made aware of the YMCA of Metropolitan Washington's COVID19 Code of Conduct, which is available online at https://www.ymcadc.org/covid19-code-of-conduct/ and that I agree to observe the YMCA's policies and procedures as outlined on this page and as they may be amended from time to time. I also understand that I am responsible for reading and complying with related notices that are posted or sent to my attention.

I Agree

 

MARKETING RELEASE

I 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 Agree

AUTHORITY

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 Agree

 

PERSONAL PROPERTY

My signature acknowledges that 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

 

ACCEPTANCE and AGREEMENT

I have read the Guest Waiver Form and agree with all Terms and Conditions stated above on the date of this visit and for all future visits to the YMCA.

I Agree

 

First Guest Name

First Name*

Last Name*

Phone*
First Guest Date of Birth*
First Guest Information

Gender Identification *
First Guest Signature*
Second Guest Name

First Name*

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

Gender Identification *
Third Guest Name

First Name*

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

Gender Identification *
Fourth Guest Name

First Name*

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

Gender Identification *
Fifth Guest Name

First Name*

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

Gender Identification *
Sixth Guest Name

First Name*

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

Gender Identification *
Seventh Guest Name

First Name*

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

Gender Identification *
Eighth Guest Name

First Name*

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

Gender Identification *
Ninth Guest Name

First Name*

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

Gender Identification *
Tenth Guest Name

First Name*

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

Gender Identification *
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
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last 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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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 *
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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