Summit Area YMCA Membership Waiver

Summit Area YMCA Membership Waiver

In an effort to keep our members and facilities safe, and in order to use the facilities, all members and guests 18+ years and a parent/guardian for minor participants under the age of 18 are required to agree and sign our Waiver and Release of Liability, Billing Terms & Conditions and Member's Code of Conduct.
Are you completing the waiver for a minor under age 18?*

YesNo
MEMBER INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Phone Number*
ex. 555-555-5555
Email*
example@example.com
PARENT/GUARDIAN INFORMATION
Name*

First NameLast Name
Relationship to Member*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Phone Number*
ex. 555-555-5555
Email*
example@example.com

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EMERGENCY CONTACT INFORMATION
Would you like to provide emergency contact information that differs from the parent/guardian information provided above?*

YesNo
Name*

First NameLast Name
Phone Number*
ex. 555-555-5555
Relationship to Member*

Continue (3/4)...
Home Branch*

Berkeley Heights YMCABerkeley Heights Community Pool at the YMCASpringfield Community PoolSummit YMCAThe Learning Circle YMCA