FOR YOUTH DEVELOPMENT
FOR HEALTHY LIVING
FOR SOCIAL RESPONSIBILITY
YMCA Membership Application
Branch:
Auburn
Skaneateles
Join Date
Membership Type
Last Name ___________________________________________________ First Name __________________________________________ M.I. __________________
Date of Birth _____________________ Age__________ Gender _____M_____F
Employer___________________________________________________
Address_______________________________________________________________________City__________________________________________Zip_______________
Telephone: Home__________________________________ Work ____________________________________________ Cell _________________________________
E-mail ___________________________________________________________________ _____________ ( ) Please do not send e-mail newsletters
Emergency contact: Name_______________________________ Phone__________________ Relationship to applicant________________________
Parent/Guardian Information (if youth membership):
Name _________________________________________________________________________________________________________ Phone ________________________________________
Family Membership (includes two adults and unmarried children through age 22)
First Name
Last Name
Gender
Birth
Age
School /Employer
Day
I decided to join the YMCA because of:
___printed advertising materials
_____taking a YMCA class
_____visiting as a guest
___encouraged by a member (member’s name) _________________________________________________________________________________________________________
___other_________________________________________________________________________________________________________________________________________________________
Photo Release
I give the Auburn YMCA-WEIU permission to use any or all portraits of myself and/or my family members for advertising,
display, printed materials or other uses.
Agreement
I understand that the YMCA-WEIU is guided by the values of honesty, caring, respect and responsibility and I agree to abide
by the policies and rules established by the Board of Directors and staff, including the Member’s Code of Conduct. I also
understand that I participate in YMCA activities and use YMCA facilities and equipment at my own risk. The Auburn YMCA-
WEIU does not carry individual accident insurance; if I become ill or injured from such use or participation, I must use my own
insurance.
Signature:_______________________________________________________________________________________________________Date
_____________
Our Mission
To put Christian principles into practice through program that build healthy spirit, mind and body for all.