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WELCOME! 

Thank you for visiting the YMCA. Please sign this Waiver Form 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: August 19, 2022

RELEASE OF LIABILITY

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


GUEST & NON-MEMBER PARTICIPANT POLICY

Guests of current YMCA members are required to pay fees to participate in tennis instruction, or to play tennis or pickleball on a court reserved by a member or via random court with a member at the YMCA Arlington Tennis & Squash Center ($20/adult or $10/child). Guests of members may visit up to 4 times annually.

Non-Member Participants in Pickleball Programs are not required to pay guest fees and there is no limit to the number of times they may participate in Pickleball drop-ins or instruction as a non-member participantMembership is required to reserve a Pickleball court. A guest fee must be paid to play on a court reserved or purchased by a member and the above policy for "guests of current YMCA members" applies.

The Tennis 7-Day Program Membership is available for out-of-town guests only to participate in tennis instruction during a 7-consecutive day period. No guest fees are charged.

I understand that 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.

I Agree
 


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 when I am at the YMCA in any capacity (i.e. member, guest, non-member participant, volunteer, etc.) 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 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 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 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 Participant Name

First Name*

Last Name*

Phone*
First Participant Date of Birth*
First Participant Information

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
First Participant Signature*
Second Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Third Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Fourth Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Fifth Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Sixth Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Seventh Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Eighth Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Ninth Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Tenth Participant Name

First Name*

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

Gender Identification *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
Participant 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

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.

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 *
The main reason I visited today is*
I am playing tennis with a permanent court time group
I am here to participate in tennis instruction
I am here to participate in pickleball instruction
I am here to play in a pickleball drop-in session
I am here to play squash
I am here today with a friend or family member that belongs to the YMCA.
A friend or a family member recommended the Y to me.
My employer recommended the Y to me.
I was in the area and decided to check out the YMCA.
I received an invitation to try the Y through the mail.
A YMCA ad peaked my interest.
I learned about the Y online.
Other

If playing with a group, please include the last name on the reservation/
I am interested in (please check all that apply)...
Discussing YMCA membership options
Learning about opportunities to be a YMCA volunteer
Donating to the YMCA
Learning how to host a party or other special event at the Y
Other

If you have selected "other" please tell us about your interests.
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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