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YMCA Arlington Membership Application

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.

Thank you for choosing to join the YMCA! 


MISSION

I understand that the YMCA of Metropolitan Washington is a non-profit charity with a mission to foster the spiritual, mental & physical development of individuals, families and communities according to the ideals of inclusiveness, equality and mutual respect for all. 

I Agree

 

CONDITIONS OF MEMBERSHIP

I understand that all members are required to present a valid membership card for identification when using YMCA facilities and/or participating in programs. If for any reason members are unable to present membership cards, they are required to present photo identification. Membership cards are not transferable; remain the property of the YMCA; and must be returned to the YMCA upon request. The YMCA conducts regular sex offender screenings on all members, participants and guests. If a sex offender match occurs, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access. Monthly membership drafts continue indefinitely unless members provide written notice of cancellation, or the YMCA terminates the membership. Annual memberships must be renewed.

I Agree
 

I understand that I will be automatically transferred into a new membership category on my birthday if I am eligible, in which event dues may increase or decrease. In the event of any other qualifying event that changes the category of membership for which I am eligible, I agree to notify the YMCA on or before the first day of the month following the month in which such event occurs.

I Agree

 

LIABILITY WAIVER

My signature acknowledges that I understand the YMCA of Metropolitan Washington assumes no responsibility for injuries or illnesses which I, my spouse/partner, or my minor children or any other person may sustain as a result of my/their physical condition, this membership, my/their use of an facility or my/their participation in any activities, programs, exercise, or the use of any equipment (collectively, “Activities”). I expressly acknowledge on behalf of myself, my spouse/partner, my minor children and our heirs that I assume the risk for any and all injuries, illnesses, death, loss or damage which may result from any of the foregoing. I hereby release and discharge the YMCA of Metropolitan Washington, its agents, servants, and employees from any and all claims for injury, illness, death, loss or damage which I, my spouse/partner, or minor children may suffer as a result of my/their physical condition, this membership, the use of any facility or participation in any Activities. In the event I, my spouse/partner or minor children bring any guest to the YMCA of Metropolitan Washington facility or Activity, I also agree to be responsible for ensuring that such guests adhere to the rules and policies of the YMCA and to inform them that they assume all liability for injuries, illness, death, loss or damage which may result from participation in any activities, programs, exercise or the use of any equipment. By participating in the YMCA Nationwide Membership Program, I 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.  Additionally, 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.

 

ACKNOWLEDGEMENT

My signature acknowledges that:

  • I have been informed of the location of the YMCA of Metropolitan Washington's Membership Handbook on the YMCA of Metropolitan Washington website (https://www.ymcadc.org/membership-handbook/), and that I agree to observe the YMCA's policies and procedures as outlined in the Membership Handbook and as they may be amended from time to time. I reserve the right to request and receive an explanation for any provision of the Membership Handbook that I do not understand.
  • I understand that I am responsible for reading and complying with notices that are posted or sent to my attention.
  • 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.

 

 

MARKETING RELEASE

I understand that the YMCA of Metropolitan Washington may take pictures or record videos of members and non-members participating in YMCA programs, using YMCA facilities, or attending YMCA special events. Additionally, I understand that the YMCA may permit members of the media to take such pictures or record such videos in order to promote the YMCA‘s charitable mission and for other journalistic purposes. Signing this membership application (if the person named below is under age 18, a parent or guardian of such person must sign on such person’s behalf) releases the YMCA and the media to use such photographs, video recordings, and/or sound recordings of me for any purpose consistent with the YMCA’s charitable mission. I understand and agree to the related Marketing policy outlined in the YMCA of Metropolitan Washington Membership Handbook, which states that I am waiving any and all rights that may preclude the YMCA’s or the media’s use of the pictures or recordings as described above, that I acknowledge that neither the YMCA nor the media has any obligation to use any recordings of me, and that I will receive no monetary payment or other compensation in exchange for the rights to use pictures or recordings of me. 

I Agree

 

MONTHLY PAYMENT AUTHORIZATION

My signature acknowledges that I understand that a month-to-month membership to the YMCA is continuous and that I agree to the following terms listed for the method of payment that I have selected to use through this application for membership to the YMCA of Metropolitan Washington:

  • BANK DRAFT: If I have elected to pay with via BANK DRAFT, I authorize my bank to honor pre-authorized drafts drawn by the YMCA on my account for membership payments and/or contributions. It is understood that my EFT membership and any recurring gift I have elected to make as I have indicated on this form will be continuous until I provide written notice to the YMCA of membership cancellation one-month prior to the date of my monthly bank draft in order to be effective for the following month. When the bank honors the draft by charging my account, such drafts constitute my receipt for the payment. Should any draft not be honored by said bank when received by them, it is understood that the payment is to be made by me in the amount of said payment, plus a service charge. If at any time there is to be a change, deletion, or cancellation of my membership and/or discontinuation of recurring gifts, it is to be submitted in writing to the YMCA branch where membership was purchased, along with my membership card(s) of cancelling membership, one-month prior to the date of my monthly bank draft in order to discontinue the debit for the following month. Failure to do so will result in that month's draft being nonrefundable. A voided check is required with all electronic funds transfer applications.
  • CREDIT CARD: If I have elected to pay with a CREDIT CARD, to ensure uninterrupted service, I authorize the YMCA to charge my credit card for membership payments and/or contributions. I understand that I must provide written notice of cancellation. If at any time there is to be a change, deletion, or cancellation of my membership and/or discontinuation of recurring gifts, it is to be submitted in writing to the YMCA where membership was purchased, along with my membership card(s) of cancelling membership, one-month prior to the date of my monthly credit card draft in order to discontinue the debit for the subsequent months.
  • FINANCIAL ASSISTANCE: in the event that I have applied for Financial Assistance, I agree to the terms of monthly payment plan and I understand that will need to re-apply annually for financial assistance.

 

MEMBERSHIP HOLDS AND CANCELLATION REQUESTS

For month-to-month memberships

  • Cancellation requests: I understand that one-month (30-days) advanced written notice is required to process membership cancellation requests. As such, I understand that:
    • if my membership payment is on the 26th, I must cancel my membership in writing by the 26th of the prior month.
    • if my membership payment is on the 10th, I must cancel my membership in writing by the 10th of the prior month.
  • Hold requests: I understand that to place a membership on hold, members must provide written notification via email to member.service@ymcadc.org at least two weeks (14-days) prior to their next draft or billing date, to include their full name, membership ID number, complete contact information (mailing address, phone number and email address), the name of the home YMCA branch, and the reason for their membership hold request. Once a membership is placed on hold, members are not permitted to use YMCA facilities (this includes with a guest pass). If member access records reflect your use of YMCA facilities while your membership is on hold, your membership will be reactivated and your account charged.  Members that place their membership on hold will pay a monthly inactive fee of $10/month for an individual / one-adult membership and $15/month for a family / two-adult membership until membership is reactivated or cancelled by the member.  To reactivate membership, please notify the YMCA via email at member.service@ymcadc.org.  
  • Cancellation and hold requests can be submitted in writing via email at member.service@ymcadc.org.

I Agree

ACCEPTANCE

I acknowledge the WAIVER and CONDITIONS OF MEMBERSHIP set forth above and in the Membership Handbook, and, being in agreement with the Mission and Goals of the YMCA of Metropolitan Washington, hereby apply for membership. 

First Member Name

First Name*

Last Name*

Phone*
First Member Date of Birth*
First Member Information

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
First Member Signature*
Second Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
Third Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
Fourth Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
Fifth Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
Sixth Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
Seventh Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
Eighth Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
Ninth Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
Tenth Member Name

First Name*

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

Gender Identification
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
How did you hear about the Y?*
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*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Employment

Employer (If not applicable, enter N/A) *

Employer Phone Number *

Occupation *
WELLNESS GOALS AND INTERESTS
I am joining the Y because I'd like to...(check all that apply) *
Improve overall health
Increase strength
Improve cardiovascular health
Increase social/family time
Prevent disease
Reduce or manage weight
Reduce or manage stress
Support the Y's mission
Rehabilitate injury/illness
Other
The Y offers health and wellness programs to meet the needs of all new members. Please select all that you are interested in.
Active aging/senior programs
Blood Pressure Self-Monitoring
Diabetes Prevention Program
Group Exercise
Healthy Cooking Classes
One-on-one dietetic counseling
Personal Training
Physical Therapy
Pickleball
Self-Defense
Sports
Swimming
Tennis
Walking/Running
Start your membership with the support of a YMCA expert. Please indicate which service area(s) you are most interested in and the YMCA will contact you to schedule your experience. *
A complimentary 60-minute personal training session
A complimentary 30-minute consultation with a dietitian
Aquatics
Pickleball
Tennis
Youth Development
None of the above
Please select the description that you feel fits you best. We look forward to meeting with you to learn more about your experiences, goals, interests, and preferences.*
Description #1: I don't exercise regularly and/or have not joined a fitness facility in a long time. I am unsure of the exercises I should be doing, and I may find exercise equipment & machines to be intimidating.
Description #2: I am familiar with fitness facilities and go when I have time. I am comfortable with using most exercise equipment and machines. I would like to add more variety to my workout routine.
Description #3: I lead an active lifestyle and follow an exercise routine with regularity. I know how to use a wide variety of exercise equipment, and I have had success in reaching my healthy living goals and/or in maintaining my desired healthy lifestyle.
Would you like to purchase a $99 Best Start program? *
PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

Regular physical activity is fun and healthy. For your safety, please carefully read and respond to all questions. 

1. Has your doctor ever said that you have a heart condition and that you should only do physical exercise recommended by a doctor?*
No
Yes
2. Do you feel pain in your chest when you take part in physical activity?*
No
Yes
3. In the past month, have you had chest pain when not taking part in physical activity?*
No
Yes
4. Do you ever lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
5. Do you have a bone or joint problem that could be adversely affected by physical activity?*
No
Yes
6. Is your doctor currently prescribing drugs for your blood pressure or heart condition?*
No
Yes
7. Do you know of any reason why you should not take part in physical activity?*
No
Yes

If you answered yes to any of the questions above, please talk with your doctor before you become physically active and provide the YMCA with medical clearance prior to beginning use of the YMCA. 

Friends of the Y

If you are friends with a current member that encouraged you to join the YMCA, please enter their full first name and last name here. We'd like to express our thanks to them for referring you to the YMCA and joining the YMCA Arlington family.
Membership Payment
The membership enrollment fee and the monthly membership dues payment have been presented and explained to me. To get started today, I will make a pro-rated membership dues payment for the remainder of the first month of membership at the YMCA in addition to the enrollment fee amount that was presented to me for the membership type and category that I have selected.*
I agree and understand the membership information presented to me. I am ready to join the YMCA.
I do not understand and/or need assistance. Please contact me.
The full details about YMCA membership (policies, fees, payments, etc.) are outlined in the membership handbook, which is subject to change, and is accessible on the YMCA website at www.ymcadc.org.*
I understand and agree.
I do not understand. Please contact me.
Please indicate your preferred method of monthly payment.*
I choose to pay through a bank draft.
I choose to pay through a credit card.
I choose to pay via check (available for annual, paid-in-full memberships only).
Please select the date of your membership payments.*
I would like to pay my monthly membership dues on the 10th of each month.
I would like to pay my monthly membership dues on the 26th of each month.
I would like to pay the annual membership dues on a one-time, paid-in-full basis each year (note that all Program Members must select this payment option, as all Program Membership are annual).
Community Support
YMCA members can directly support their community as a volunteer through a wide variety of impactful programs, services and opportunities.*
I'd like to learn more. Please contact me
I'm not interested at this time.
Would you like to make a donation to support the YMCA’s impact in your community as a non-profit charity organization?*

If you selected YES to make a donation, enter the appropriate ONE-TIME or RECURRING donation amount here. To discontinue a recurring monthly donation, please notify the YMCA via email as outlined in the monthly payment authorization section.
Family Membership Details

Complete this section only if you are enrolling in a membership for two adults (with or without children) or a one adult membership with children. For individual Adult  memberships, please skip this section.

ADDITIONAL ADULT OR SENIOR. Please list the first name, last name, birth date (MM/DD/YYYY), and gender identity of one adult or senior who lives in your household that will be joining with you. 


Additional Adult Full Name

Additional Adult Date of Birth

Additional Adult Gender Identity

Additional Adult's Email Address

CHILDREN. In each box below, please list the full name, date of birth (MM/DD/YYYY), gender identity, and email address (as applicable) of each child in your household under the age of 18 years old who will be joining your membership with you. 



First Child's Full Name

First Child's Date of Birth (MM/DD/YYYY)

First Child's Gender Identity

First Child's Email Address (as applicable)

Second Child's Full Name

Second Child's Date of Birth (MM/DD/YYYY)

Second Child's Gender Identity

Second Child's Email Address (as applicable)

Third Child's Full Name

Third Child's Date of Birth (MM/DD/YYYY)

Third Child's Gender Identity

Third Child's Email Address (as applicable)

Fourth Child's Full Name

Fourth Child's Date of Birth (MM/DD/YYYY)

Fourth Child's Gender Identity

Fourth Child's Email Address (as applicable)
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
Preferred Method of Contact
Phone
Email
Text
Please select the type of membership you'd like to apply for at this time:*
I would like to join the YMCA with the full membership privileges at my local YMCA branch. This YMCA membership provides access to my home YMCA branch facility and the opportunity to access other YMCA branches outside of this area through the nationwide membership program, as available. This membership includes the opportunity to participate in YMCA membership value-added programs and services and the opportunity to purchase additional fee-based programs and services at a discount.
I would like to participate in YMCA programs only through a Program Membership. This membership provides the opportunity to purchase YMCA fee-based programs and services. YMCA facility access is limited to just what is needed to support my participation in the specific YMCA programs and services that have been purchased.
Please select your membership category*
Young Adult (individual age 18 - 22 years old)
Young Professional (individual age 23-29 years old)
Adult (individual age 23 - 64 years old)
Family 1 (one adult individual, with children ages 17 and younger living in the same household)
Family 2 (two adult individuals, with or without children ages 17 and younger living in the same household).
Senior (individual age 65+ years old)
Senior Couple (two individuals, both ages 65+, living in the same household)
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Parent or Guardian's Signature*
Electronic Signature Consent*
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