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YMCA Arlington Tennis & Squash Center

Program Membership Application - Junior

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

 

MEMBERSHIP HOLD AND CANCELLATION 

I understand that the annual Program membership payment made to the YMCA Arlington Tennis & Squash Center is non-refundable. Annual Program memberships to the YMCA Arlington Tennis & Squash Center may not be placed on hold, as an annual Program membership to the YMCA Arlington Tennis & Squash Center is continuous for one year from the date of enrollment. Refunds and/or credits will not be issued for non-usage. In the event that a YMCA branch closes for a full month in compliance with a government mandate or health official requirement, members have the option of donating the corresponding portion of their annual program membership dues payment to the YMCA or receiving a credit for each full month that the Y was closed. No credits will be issued for partial month closure.

I Agree

 

ACCEPTANCE

In signing this application on behalf of my youth, 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 Program membership to the YMCA Arlington Tennis & Squash Center.

I Agree


First Member Name

First Name*

Last Name*

Phone*
First Member Date of Birth*
First Member Information

Gender Identification
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
How did you hear about the Y?*
Third Member Name

First Name*

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

Gender Identification
How did you hear about the Y?*
Fourth Member Name

First Name*

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

Gender Identification
How did you hear about the Y?*
Fifth Member Name

First Name*

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

Gender Identification
How did you hear about the Y?*
Sixth Member Name

First Name*

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

Gender Identification
How did you hear about the Y?*
Seventh Member Name

First Name*

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

Gender Identification
How did you hear about the Y?*
Eighth Member Name

First Name*

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

Gender Identification
How did you hear about the Y?*
Ninth Member Name

First Name*

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

Gender Identification
How did you hear about the Y?*
Tenth Member Name

First Name*

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

Gender Identification
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*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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 family.
Membership Payment
The program membership enrollment fee and annual program membership dues payment have been presented and explained to me. To get started today, I will make the full annual membership dues payment (or a pro-rated membership dues payment for the remainder of the year) in addition to the enrollment fee amount that was presented to me for the Program 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 annual payment.*
I choose to pay through a bank draft.
I choose to pay through a credit card.
I choose to pay via check.
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.
YMCA members have the opportunity to support the Y's work as donors.*
I would like to make a one-time gift to the YMCA. Please contact me.
I would like to make a recurring monthly donation to the YMCA. Please contact me.
I am not interested at this time.
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Gender Identification
How did you hear about the Y?*
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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