Membership For All Assistance Information
THE ESSENCE OF THE Y
With a commitment to nurturing the potential of kids, promoting healthy living and fostering a sense of social responsibility, the YMCA of the Chippewa Valley ensures that every individual has access to the essentials needed to learn, grow and thrive.
EVERYONE IS WELCOME
The YMCA welcomes all who wish to participate and believes that no one should be denied access to the Y based on their ability to pay. Through our Membership for All Program, the YMCA of the Chippewa Valley provides assistance to youth, adults and families based on individual needs and circumstances.
COMMITTED TO OUR COMMUNITY
Determination of assistance amounts is handled by the YMCA in a fair and consistent manner. Every YMCA member receives the same membership benefits, regardless of whether or not they receive assistance. YMCA members can feel confident knowing they are a part of an organization that cares greatly for the well-being of all people and is committed of youth development, healthy living and social responsibility.
*Percentage listed reflects the amount your fees will be discounted. This assistance is only available for youth, adult, and family memberships. Young adult and senior memberships are already discounted and not eligible for assistance
Frequently Asked Questions
How do I apply?
Applications are available at the Member Service Desk or online at www.ymca-cv.org under the membership section. Verification of income is required to apply for MFA. Acceptable forms include: 1) Latest 1040 Tax form (members can bring in their latest Form 1040 at any time to adjust if needed); 2) SSI or SSDI Award Letter; 3) Badger Care Benefit Letter; 4) Unemployment verification. If you do not have the verification documents above or have experienced a change in income within the past year, you must meet with our Membership Director to apply for membership or program assistance. To set up a meeting, call 715-836-8460 (EC) or 715-723-2201 (CF) and ask for a membership and program assistance meeting.
What is considered a household?
A household is defined as any 2 adults with dependent children up to the age of 23, verified on IRS Form 1040.
How do membership payments work?
There are 3 options to pay for a financial assistance membership. Annual payment (12 months) or quarterly payments (every 3 months) can be made at the Member Service Desk. Monthly payments can be made using the automated bank draft (from credit card or checking account).
How long does my Membership for All assistance last?
Membership for All is redeemable for 1 year. If at any point your membership payments fall behind, you must back pay missed months until active again or wait until your MFA expiration date to reapply.
What if I don't have all the paperwork needed?
If you do not have the verification documents above or have experienced a change in income within the past year, you must meet with our Membership Director to apply for membership or program assistance. To set up a meeting, call 715-836-8460 (EC) or 715-723-2201 (CF) and ask for a membership and program assistance meeting.
Name of Applicant
Please choose one of the following:
This is my first time applying for assistance through the YMCA
I have received YMCA assistance before, but it has been over 6 months
I am renewing my YMCA assistance
I am applying for...
Family/Household Membership Assistance
Adult Membership Assistance
Youth Membership Assistance
Camp Manitou Campership
Full Day Care for School Aged Children
I currently reside in...
How Many in Household:
Total Annual Household Income
Please present tax return to our Customer Service Staff at the Member Service Desk
Upload Proof of Income (ex. 1040, SSI, or SSDI) You may take a photo of your document. If you do not have a copy to upload, please bring your proof of income to the Service Desk in addition to submitting this form.
You may upload multiple files
TELL US MORE...Use this space to include any additional information or extenuating circumstances that were not included on this application.
Social Worker or Sponsor (if applicable)
Name and phone number
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Date of Birth
Are you currently receiving or applying for county assistance for child care?
Does Not Apply
ALL PERSONS LIVING IN THIS HOUSEHOLD
THIS APPLICATION MUST BE RENEWED EVERY 12 MONTHS!
I certify that the information I have submitted is true and complete to the best of my knowledge and that I do not have additional income not represented below. I agree, if necessary, to send additional information and documentation to support the above statements. I understand that financial assistance is based on need. In the event that I or my children must cancel our participation, I will contact the YMCA immediately so assistance can be provided to others. I understand that if I falsify any information below, I will not be eligible for assistance now and/or in the future.
Signature of person completing this form
RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
In consideration of participating in YMCA of the Chippewa Valley activities, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence the YMCA of the Chippewa Valley and its owners, directors, officers employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows:1. I acknowledge that participating in INSURED activities, including onsite, virtual, and pre-recorded on video activities, involves known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, broken bones, exposure to our contracting of communicable diseases, torn ligaments or other injuries as a result of falls or contact with other participants; death as a result of drowning or brain damage caused by near drowning in pools or other bodies of water; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity.2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation.3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition.5. In the event that I file a lawsuit, I agree to do so in the state where Releasees’ facility is located, and I further agree that the substantive law of that state shall apply.6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
By signing this document,
I agree that if I am hurt or my property is damaged during my participation in these activities, whether onsite, video, recorded, virtual, or otherwise, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms.
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