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Gateway Region YMCA Conditions of Facility Access

The Y reserves the right to cancel a membership at any time. Any member, guest, or applicant whose actions are not deemed to be in the best interests of the organization may have their membership or application denied.

MEMBER'S RESPONSIBILITY IN CONNECTION WITH USE OF THE FACILITY: You (each member of your family and all guests) should consult with a physician before using our services and facilities. You agree that you will not use the facilities with any medical condition, including open cuts, abrasions, sores, infections, maladies or inability to maintain personal hygiene, if such condition poses a direct threat to yourself or to others. It is our goal to provide services to ALL in our community. If using Child Watch or other programs, please provide a copy of a current IEP/BMP/504 Student Accommodation Plan. Although every effort is made to provide reasonable accommodations, there may be instances where a participant's needs may exceed the parameters of the scope of the requested service/program. Failure to comply with this agreement could result in suspension or termination of membership privileges.

ASSUMPTION OF RISK: You (each family member and guests) agree that if you engage in any physical exercise or activity, use any of the branch facilities or enter the premises of the branch you do so at your own risk. This includes, without limitation, your use of the locker room, any pool, whirlpool, sauna, steam room, or any equipment within the branch and your participation in any activity, class, program or instruction as well as your use of or presence on the parking area or sidewalk. You agree that you are voluntarily participating in these activities. You assume all risk of injury or the risk of contraction of any illness or medical condition that might result, or any damage, loss or theft of any personal property.

PHOTOGRAPH & VIDEO RELEASE: For adequate sufficient consideration the receipt of which is hereby acknowledged, the applicant(s) hereby gives permission for the YMCA to use, without limitation, photographs, film footage or tape recordings which may include the applicant(s) image or voice for purposes of promoting or interpreting YMCA programs.

SEX OFFENDER REGISTRY: 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.

NATIONWIDE MEMBERSHIP ACCESS: 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.

WAIVER AND RELEASE OF LIABILITY: In return for use of the facilities of or entry on the premises of the branch, you agree on behalf of yourself (and each family member and guest) to not sue and to release from any and all liability the Gateway Region YMCA (and our affiliates, employees, agents, representative, successors and assigns) from any and all claims or causes of action (known or unknown) arising out of negligence of the Gateway Region YMCA. This waiver of release and liability includes, but is not limited to, injuries which may occur as a result of (a) Your use of any exercise equipment or facilities, which may malfunction or break; (b) Our improper maintenance of any exercise equipment or facilities, which may malfunction or break; (c) Our NEGLIGENT instruction or supervision; (d) Your slipping and falling while in the branch or on the premises including parking areas and sidewalks.

INDEMNIFICATION AND HOLD HARMLESS: You further agree that You WILL INDEMNIFY AND HOLD HARMLESS THE GATEWAY REGION YMCA THEIR OFFICERS, AGENTS, AND EMPLOYEES, from any loss, liability, damages or cost of any kind that THE YMCA may incur as the result of any injury to yourself or to any member of your family even if it is contended that any such injury was caused by NEGLIGENCE of the part of the Gateway Region YMCA. 


July 7, 2026

First Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's/Guest Date of Birth*
Date of Birth
First Participant's/Guest Signature*
Second Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
Third Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
Fourth Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
Fifth Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
Sixth Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
Seventh Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
Eighth Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
Ninth Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
Tenth Participant's/Guest Name
First Name*
Last Name*
Phone*
Select Gender
Participant's/Guest Date of Birth*
Date of Birth
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
Medical Authorization
Medical Authorization
Do you authorize medical care for you and your minor children?*
No
Yes

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. You warrant that you are the parent of the child participating in this event and that you are fully competent to sign this Waiver; that you understand the terms contained herein are contractual and not a mere recital; that you have read this Waiver with full knowledge of its significance; and that you have signed this Waiver as your own free act. 



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*
Relationship*
Phone*
Select Gender
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 Date of Birth*
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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