Ymca Membership Application printable pdf download

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.

Ymca Membership Application

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